Concho Valley Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CONCHO VALLEY FAMILY DENTAL

Practice address

2102 Pecos St Ste 1
San Angelo, TX 76901-3061

Phone

(325) 944-4984

NPI assigned

Sep 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jay Fandel, DMDNPI 1417040940

Title

Owner / Dentist

Phone

(602) 466-5687

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jay Edward Fandel, D.M.D.

  • Dentist
  • San Angelo, TX
  • NPI 1417040940
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1083337240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 PECOS ST STE 1",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769013061",
            "telephone_number": "325-944-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 PECOS ST STE 1",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769013061",
            "telephone_number": "325-944-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCHO VALLEY FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "FANDEL",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "OWNER / DENTIST",
        "authorized_official_telephone_number": "602-466-5687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Concho Valley Center for Human Advancement
• Concho Valley Chiropractic PLLC
• Concho Valley Council of Governments
• Concho Valley Emergency Physicians PLLC
• Concho Valley Errand Services
• Concho Valley Family Dental, P.a.
• Concho Valley Hematology & Oncology, PLLC
• Concho Valley HHC of West TX LLC
• Concho Valley Medicine, LLC
• Concho Valley Rehab, P.a.

• General Practice Dentistry in San Angelo, TX
• Providers in San Angelo, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.