Provider Demographics
NPI:1629839055
Name:NAGEL, CAILEY (RDH)
Entity Type:Individual
Prefix:
First Name:CAILEY
Middle Name:
Last Name:NAGEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 S TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4395
Mailing Address - Country:US
Mailing Address - Phone:515-825-7042
Mailing Address - Fax:
Practice Address - Street 1:2133 S TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4395
Practice Address - Country:US
Practice Address - Phone:970-699-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-04-11
Deactivation Date:2024-03-31
Deactivation Code:
Reactivation Date:2024-04-11
Provider Licenses
StateLicense IDTaxonomies
CODH.002026428124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist