Provider Demographics
NPI:1790859866
Name:NAGELE, DAVID CHARLES (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHARLES
Last Name:NAGELE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 N LITTELFUSE LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970
Mailing Address - Country:US
Mailing Address - Phone:815-432-5421
Mailing Address - Fax:815-432-4170
Practice Address - Street 1:130 N LITTELFUSE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970
Practice Address - Country:US
Practice Address - Phone:815-432-5421
Practice Address - Fax:815-432-5421
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A141181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003095Medicaid