Provider Demographics
NPI:1407489610
Name:FAGIN DENTAL CORPORATION
Entity Type:Organization
Organization Name:FAGIN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGIN-HUTCHINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:949-554-4434
Mailing Address - Street 1:11925 N RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-7075
Mailing Address - Country:US
Mailing Address - Phone:949-554-4434
Mailing Address - Fax:
Practice Address - Street 1:7055 N FRESNO ST STE 203A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2957
Practice Address - Country:US
Practice Address - Phone:559-435-0966
Practice Address - Fax:559-435-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty