Mark Charles Fagan in San Jose - Periodontics
Mark Charles Fagan - NPI 1376562827
Mark Charles Fagan is a Periodontics in San Jose, California. Mark Charles Fagan practices all healthcare services and medical treatments related to Periodontics. The NPI Number for Mark Charles Fagan is 1376562827. The last update date is 2007-07-08.
Mark Charles Fagan's current location address is 1660 Willow St, San Jose, California. You can contact this provider via phone number 4082691060. The mailing address for Mark Charles Fagan is 1660 Willow St, San Jose, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Mark Charles Fagan |
|---|---|
| Address | 1660 Willow St, San Jose, California |
| Phone Number | 4082691060 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | D.D.S. |
NPI Number Detail
| NPI Number | 1376562827 |
|---|---|
| Provider Enumeration Date | 2006-07-18 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 1660 Willow St |
|---|---|
| City | San Jose |
| State | California (CA) |
| Post Code | 951255101 |
| Phone Number | 4082691060 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Periodontics |
|---|---|
| Taxonomy | 1223P0300X |
| Licence No | 38419 |
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Definition: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structure |
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Post Comment/ Review Below
What is the unique identification code assigned to Mark Charles Fagan by the Centers for Medicare & Medicaid Services?
The Mark Charles Fagan has been issued the NPI (National Provider Identifier) 1376562827. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete street address where Mark Charles Fagan is physically located?
The Mark Charles Fagan is physically situated at the following address: 1660 Willow St, San Jose, CA, 951255101.
What is Mark Charles Fagan's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Mark Charles Fagan is Periodontics, and the taxonomy classification code that categorizes this area of expertise is 1223P0300X.
On what date did the Mark Charles Fagan receive the assignment of its 1376562827 from the Centers for Medicare & Medicaid Services?
The Mark Charles Fagan was issued its 1376562827 by the Centers for Medicare & Medicaid Services on 2006-07-18.
As of what date was the information pertaining to Mark Charles Fagan, such as address, specialty, and other details, last reviewed and confirmed to be accurate?
The information related to Mark Charles Fagan, including its address, specialty, and other relevant details, was last reviewed and confirmed to be accurate on 2007-07-08.