Provider Demographics
NPI:1649241092
Name:NAGATANI, BRETT M (DDS)
Entity Type:Individual
Prefix:PROF
First Name:BRETT
Middle Name:M
Last Name:NAGATANI
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 1:11551 AMALFI WAY
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4099
Mailing Address - Country:US
Mailing Address - Phone:323-440-3584
Mailing Address - Fax:
Practice Address - Street 1:925 W 34TH ST STE 124C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0641
Practice Address - Country:US
Practice Address - Phone:213-740-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552661223E0200X
TX223751223E0200X
HIDT - 22761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics