Active NPI
Angel Fernando Mogrovejo Fajardo, DDS, MS
- Periodontics
- Williamsburg, VA
National Provider Identifier
1831532829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401415449
- Practice address
- 461 McLaws Cir Ste 1
Williamsburg, VA 23185-6350 - Phone
- (757) 221-0249
- NPI assigned
- Apr 10, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401415449 | VA | Primary |
Addresses
Primary practice location
461 McLaws Cir Ste 1
Williamsburg, VA 23185-6350
Mailing address
461 McLaws Cir Ste 1
Williamsburg, VA 23185-6350
Phone (757) 221-0249
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401415449 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552262400000",
"number": "1831532829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "461 MCLAWS CIR STE 1",
"city": "WILLIAMSBURG",
"state": "VA",
"postal_code": "231856350",
"telephone_number": "757-221-0249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "461 MCLAWS CIR STE 1",
"city": "WILLIAMSBURG",
"state": "VA",
"postal_code": "231856350",
"telephone_number": "757-221-0249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGROVEJO FAJARDO",
"first_name": "ANGEL",
"middle_name": "FERNANDO",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-10",
"last_updated": "2019-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401415449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamsburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.