Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. MARK W FAGAN, DDS
ActiveDR. MARK W FAGAN, DDS is a Pediatric Dentistry healthcare provider located in FORT DRUM, New York. NPI 1588612790 is currently active in the NPPES registry. Verify at CMS.
Pediatric Dentistry · FORT DRUM, NY
Registration Details
- NPI Number
- 1588612790
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 4, 2006 (20.325214761808 yrs)
- Last Updated
- Jun 30, 2022
- License
-
11964 (MD)
Practice Information
- Address
-
10205 N RIVA RIDGE LOOPFORT DRUM, NY, 136025457Browse NY providers · Browse ZIP 13602
- Phone
- 3157725088
- Primary Specialty
-
Pediatric Dentistry
1223P0700X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.