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General NPI Number Information
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NPI Number | 1457802175
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Entity Type | Organization
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Legal Business Name | THOMAS G FAGOT DDS PC
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 1220 N ADAMS ST
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City | LEXINGTON
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State | NE
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Zip | 68850-1621
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Country | US
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Telephone | 308-324-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 N ADAMS ST P.O. BOX 940
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City | LEXINGTON
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State | NE
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Zip | 68850-1621
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Country | US
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Telephone | 308-324-7422
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Fax |
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Authorized Official
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Title or Position | DOCTOR/BUSINESS MANAGER
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Name | DR. THOMAS GEORGE ALEXANDER
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Credential | DDS
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Telephone | 308-324-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6905
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License Number State | NE
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