Provider Demographics
NPI:1740695527
Name:FAGIN, ADAM PETER (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PETER
Last Name:FAGIN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N SAN MATEO DR STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2675
Mailing Address - Country:US
Mailing Address - Phone:650-342-0213
Mailing Address - Fax:
Practice Address - Street 1:235 N SAN MATEO DR STE 600
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2675
Practice Address - Country:US
Practice Address - Phone:650-342-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-008431223S0112X
CA1035191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty