Provider Demographics
NPI:1841630787
Name:NAGLE, BRYAN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LEE
Last Name:NAGLE
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 1:770 S RANGE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-2967
Mailing Address - Country:US
Mailing Address - Phone:785-460-3922
Mailing Address - Fax:785-460-9699
Practice Address - Street 1:770 S RANGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2967
Practice Address - Country:US
Practice Address - Phone:785-460-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016297122300000X
KS61235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist