Provider Demographics
NPI:1508950924
Name:NAGER, MARTIN CRAIG (DMD)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:CRAIG
Last Name:NAGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 JEFFERSON BOULVARD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-1053
Mailing Address - Country:US
Mailing Address - Phone:401-781-2742
Mailing Address - Fax:401-781-2740
Practice Address - Street 1:67 JEFFERSON BOULVARD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1053
Practice Address - Country:US
Practice Address - Phone:401-781-2742
Practice Address - Fax:401-781-2740
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDNT 22621223P0300X
MADN16220-11223P0300X
RIDNT22621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics