David Keith Fagundes, D.M.D.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

11435 Issued in GA

Practice address

105 Parker Dr
Suite a
Lagrange, GA 30240-6436

Phone

(706) 884-3636

Fax

(706) 884-8490

NPI assigned

Nov 1, 2006

Last updated

May 7, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• D. K. Fagundes Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1184701815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 PARKER DR",
            "address_2": "SUITE A",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302406436",
            "telephone_number": "706-884-3636",
            "fax_number": "706-884-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PARKER DR",
            "address_2": "SUITE A",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302406436",
            "telephone_number": "706-884-3636",
            "fax_number": "706-884-8490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGUNDES",
        "first_name": "DAVID",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "11435",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "AL",
            "license": "4564",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INSURANC",
            "identifier": "971792",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "D.",
            "last_name": "FAGUNDES",
            "middle_name": "K.",
            "credential": "D.M.D., M.S., P.C.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Endodontics in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Endodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; 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.