Provider Demographics
NPI:1639382351
Name:DEVINDERPAL SINGH NAGRA
Entity Type:Organization
Organization Name:DEVINDERPAL SINGH NAGRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-215-7937
Mailing Address - Street 1:815 W HOLT BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3681
Mailing Address - Country:US
Mailing Address - Phone:909-635-0444
Mailing Address - Fax:
Practice Address - Street 1:815 W HOLT BLVD STE 402
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3681
Practice Address - Country:US
Practice Address - Phone:909-635-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9030104OtherDENTICAL ID