Individual
DR. DAVID KEITH FAGUNDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
105 PARKER DR, SUITE A, LAGRANGE, GA 30240-6436
(706) 884-3636
(706) 884-8490
Mailing address
105 PARKER DR, SUITE A, LAGRANGE, GA 30240-6436
(706) 884-3636
(706) 884-8490
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
11435
GA
1223E0200X
Endodontics
4564
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
971792
UNITED CONCORDIA INSURANC
—
Enumeration date
11/01/2006
Last updated
05/07/2020
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