Provider Demographics
NPI:1114948510
Name:FAGIN, MARSHALL DARYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:DARYL
Last Name:FAGIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6471 TRANSIT RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1427
Mailing Address - Country:US
Mailing Address - Phone:716-633-7070
Mailing Address - Fax:716-689-6327
Practice Address - Street 1:6471 TRANSIT RD
Practice Address - Street 2:SUITE #1
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1427
Practice Address - Country:US
Practice Address - Phone:716-633-7070
Practice Address - Fax:716-689-6327
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0307951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics