Provider Demographics
NPI:1376985333
Name:NAGY, WHITNEY TEAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:TEAL
Last Name:NAGY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 NW 13TH AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:926 NW 13TH AVE
Practice Address - Street 2:STE 150
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3081
Practice Address - Country:US
Practice Address - Phone:503-227-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014141301223G0001X
ORD99981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice