Active NPI
Jan P Fugal, DDS
- Dentist
- Ballston Spa, NY
National Provider Identifier
1205042736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- NY052523-1
- Practice address
- 348 Milton Ave
Ballston Spa, NY 12020-1415 - Phone
- (518) 885-7551
- Fax
- (518) 885-8060
- NPI assigned
- May 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | NY052523-1 | NY | Primary |
| Dentist | 122300000X | 5620-015 | WI |
Addresses
Primary practice location
348 Milton Ave
Ballston Spa, NY 12020-1415
Mailing address
348 Milton Ave
Ballston Spa, NY 12020-1415
Phone (518) 885-7551
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NY052523-1 | NY | MD | Dentist |
| 5620-015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205042736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "348 MILTON AVE",
"city": "BALLSTON SPA",
"state": "NY",
"postal_code": "120201415",
"telephone_number": "518-885-7551",
"fax_number": "518-885-8060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "348 MILTON AVE",
"city": "BALLSTON SPA",
"state": "NY",
"postal_code": "120201415",
"telephone_number": "518-885-7551",
"fax_number": "518-885-8060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUGAL",
"first_name": "JAN",
"middle_name": "P",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "NY052523-1",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "5620-015",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ballston Spa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.