Provider Demographics
NPI:1982772737
Name:FAGIN-HUTCHINGS, MARK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FAGIN-HUTCHINGS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:FAGIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:303 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3127
Mailing Address - Country:US
Mailing Address - Phone:949-554-4434
Mailing Address - Fax:949-566-9282
Practice Address - Street 1:2701 W FIRST ST #15
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703
Practice Address - Country:US
Practice Address - Phone:714-480-3085
Practice Address - Fax:714-895-1368
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223X0400X1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics