John Jerome Fagel, DMD
Individual provider Active NPI General Practice Dentistry · Tohatchi, NM
NPI 1639725732 · NPPES record last updated Aug 14, 2019
Key facts
- NPI
- 1639725732
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 10339 (KY)
- Practice address
- 07 Choos Gai Dr
Tohatchi, NM 87325 - Phone
- (505) 733-8100
- NPI assigned
- Aug 14, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10339 | KY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10339 | KY | Yes |
Addresses
Primary practice location
07 Choos Gai Dr
Tohatchi, NM 87325
Mailing address
851 Twilight Dr
Crescent Springs, KY 41017-4488
Phone (859) 496-4647
Other providers in Tohatchi, NM
- Sadie M. Benallie
- Kristine Cruz
- Dezbaa Altaalkii Damon-Mallette
- DHHS, PHS, Naihs, Gallup Indian Medical Center
- Carrie Edsitty
- Robert H Fernando
- Anna George
- Camilo Gonzalez Jr.
- Rolanda Hardy
- Georgia Ann Henry
All providers in Tohatchi, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.