NPIMap

Organization Active NPI

Jose L. Fajardo, D.M.D,P.C.

  • Dentist
  • Norcross, GA
National Provider Identifier
1609082122
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
011347 Issued in GA
Legal business name
JOSE L. FAJARDO, D.M.D,P.C.
Practice address
5720 Buford Hwy
Suite 101
Norcross, GA 30071-2577
Phone
(770) 368-1818
Fax
(770) 368-1618
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Authorized official

Name
Dr. Jose Luis Fajardo, D.M.DNPI 1124423934
Title
Dentist
Phone
(770) 368-1818

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 011347 GA Primary

Addresses

Primary practice location

5720 Buford Hwy
Suite 101
Norcross, GA 30071-2577

Mailing address

5720 Buford Hwy
Suite 101
Norcross, GA 30071-2577
Phone (770) 368-1818

National Provider Directory

National Provider Directory

Locations

5720 Buford Hwy
Ste 101
Norcross, GA 30071
Phone (770) 368-1818

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1609082122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5720 BUFORD HWY",
            "address_2": "SUITE 101",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300712577",
            "telephone_number": "770-368-1818",
            "fax_number": "770-368-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5720 BUFORD HWY",
            "address_2": "SUITE 101",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300712577",
            "telephone_number": "770-368-1818",
            "fax_number": "770-368-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSE L. FAJARDO, D.M.D,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-368-1818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "011347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; 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.