Provider Demographics
NPI:1033804075
Name:FAGAN, BREA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BREA
Middle Name:
Last Name:FAGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 PERSHING DR APT 327
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-7445
Mailing Address - Country:US
Mailing Address - Phone:410-251-4932
Mailing Address - Fax:
Practice Address - Street 1:815 PERSHING DR APT 327
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-7445
Practice Address - Country:US
Practice Address - Phone:410-251-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program