Provider Demographics
NPI:1386854255
Name:FAGIOLI, JOHN H (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:FAGIOLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 DRUM POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6902
Mailing Address - Country:US
Mailing Address - Phone:732-477-8090
Mailing Address - Fax:732-477-2016
Practice Address - Street 1:526 DRUM POINT RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6902
Practice Address - Country:US
Practice Address - Phone:732-477-8090
Practice Address - Fax:732-477-2016
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01476800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist