Provider Demographics
NPI:1083773568
Name:NAEGELI, DAVID GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GORDON
Last Name:NAEGELI
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 1:1004 CARDINAL CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-5804
Mailing Address - Country:US
Mailing Address - Phone:715-386-2112
Mailing Address - Fax:
Practice Address - Street 1:8980 HUDSON BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-9704
Practice Address - Country:US
Practice Address - Phone:651-735-9057
Practice Address - Fax:651-501-1471
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND84221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice