Provider Demographics
NPI:1912203100
Name:ELNAGGAR, MAGED MINA (DDS)
Entity Type:Individual
Prefix:
First Name:MAGED
Middle Name:MINA
Last Name:ELNAGGAR
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 1:8500 HATILLO AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1421
Mailing Address - Country:US
Mailing Address - Phone:818-667-8257
Mailing Address - Fax:
Practice Address - Street 1:8500 HATILLO AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1421
Practice Address - Country:US
Practice Address - Phone:818-667-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist