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General NPI Number Information
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NPI Number | 1518030089
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Entity Type | Organization
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Legal Business Name | JAGOR AND JAGOR D.D.S.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5555 PEACHTREE DUNWOODY RD NE SUITE G-90
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City | ATLANTA
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State | GA
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Zip | 30342-1703
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Country | US
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Telephone | 404-256-2551
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Fax | 404-256-2557
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Provider Business Mailing Address
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Address Line | 5555 PEACHTREE DUNWOODY RD NE SUITE G-90
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City | ATLANTA
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State | GA
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Zip | 30342-1703
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Country | US
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Telephone | 404-256-2551
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Fax | 404-256-2557
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Authorized Official
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Title or Position | CEO
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Name | DR. THOMAS C JAGOR
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Credential | DDS
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Telephone | 404-256-2551
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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 | DN005683
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN009744
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License Number State | GA
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