Provider Demographics
NPI:1336664622
Name:NAGA, OSAMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:
Last Name:NAGA
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 1:15887 CUMBERLAND RD STE 104
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4332
Mailing Address - Country:US
Mailing Address - Phone:317-770-4783
Mailing Address - Fax:
Practice Address - Street 1:15887 CUMBERLAND RD STE 104
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4332
Practice Address - Country:US
Practice Address - Phone:317-770-4783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013513A122300000X
ORD10714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist