Provider Demographics
NPI:1275649949
Name:H ROBERT NAGEL DDS DAVID A CUTRELL DMD LISA M WENDELL DMD PC
Entity Type:Organization
Organization Name:H ROBERT NAGEL DDS DAVID A CUTRELL DMD LISA M WENDELL DMD PC
Other - Org Name:THE ENDODONTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-872-4897
Mailing Address - Street 1:55 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702
Mailing Address - Country:US
Mailing Address - Phone:508-872-4897
Mailing Address - Fax:508-620-9261
Practice Address - Street 1:55 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-872-4897
Practice Address - Fax:508-620-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118411223E0200X
MA126661223E0200X
MA171901223E0200X
199851223E0200X
197811223E0200X
202801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty