Provider Demographics
NPI:1730149840
Name:NAGAVI, NADER N (DDS)
Entity type:Individual
Prefix:
First Name:NADER
Middle Name:N
Last Name:NAGAVI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 SELMA LN
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6342
Mailing Address - Country:US
Mailing Address - Phone:614-288-6827
Mailing Address - Fax:
Practice Address - Street 1:7625 VIA CAMPANILE STE 130
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8489
Practice Address - Country:US
Practice Address - Phone:760-633-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225411223G0001X
OH216501223D0001X
CA1035691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2343753Medicaid