Provider Demographics
NPI:1871747774
Name:NAGAL, ROGER CONCEPCION (DMD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CONCEPCION
Last Name:NAGAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E 8TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2300
Mailing Address - Country:US
Mailing Address - Phone:619-474-7279
Mailing Address - Fax:
Practice Address - Street 1:450 E 8TH ST STE E
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2300
Practice Address - Country:US
Practice Address - Phone:619-474-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92672-01OtherDENTI-CAL
CAG92672-01OtherDELTA DENTAL