| |
20913 Sherman Way Canoga Park CA 91303-1743 | |
(818) 992-4600 | |
(818) 992-4602 |
Full Name | |
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Speciality | Dentist |
Location | 20913 Sherman Way, Canoga Park, California |
Authorized Official Name and Position | Maged M Elnaggar (DENTIST) |
Authorized Official Contact | 8186678257 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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20913 Sherman Way Canoga Park CA 91303-1743 Ph: (818) 992-4600 | 20913 Sherman Way Canoga Park CA 91303-1743 Ph: (818) 992-4600 |
NPI Number | 1427447028 |
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Provider Enumeration Date | 01/20/2015 |
Last Update Date | 08/05/2020 |
Medicare PECOS PAC ID | 5799100699 |
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Medicare Enrollment ID | O20200810002141 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427447028 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 60170 (California) | Primary |
Provider Name | Maged Mina Elnaggar |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1912203100 PECOS PAC ID: 6608291505 Enrollment ID: I20200811001753 |
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