# JOSE L. FAJARDO, D.M.D,P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609082122
- **Authorized official:** DR. JOSE LUIS FAJARDO D.M.D (DENTIST)
- **Authorized official phone:** (770) 368-1818

## Contact information

- **Practice address:** 5720 BUFORD HWY, SUITE 101, NORCROSS, GA 30071-2577
- **Practice address phone:** (770) 368-1818
- **Practice address fax:** (770) 368-1618
- **Mailing address:** 5720 BUFORD HWY, SUITE 101, NORCROSS, GA 30071-2577
- **Mailing address phone:** (770) 368-1818
- **Mailing address fax:** (770) 368-1618

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 011347 | GA | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 10/03/2014