Provider Demographics
NPI:1144388141
Name:ELSEMARY, NAGY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAGY
Middle Name:R
Last Name:ELSEMARY
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 1:8664 FESTIVAL DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4570
Mailing Address - Country:US
Mailing Address - Phone:916-803-2894
Mailing Address - Fax:
Practice Address - Street 1:9045 BRUCEVILLE RD STE 160
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5902
Practice Address - Country:US
Practice Address - Phone:916-683-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice