Individual
JOHN JEROME FAGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
07 CHOOS GAI DR, TOHATCHI, NM 87325
(505) 733-8100
Mailing address
851 TWILIGHT DR, CRESCENT SPRINGS, KY 41017-4488
(859) 496-4647
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10339
KY
Other
Enumeration date
08/14/2019
Last updated
08/14/2019
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