Provider Demographics
NPI:1477763357
Name:JOHN H. FAGIOLI, DMD, PA.
Entity Type:Organization
Organization Name:JOHN H. FAGIOLI, DMD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAGIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-477-8090
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014768001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty