# TIMOTHY B FAGAN DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982717369
- **Authorized official:** DR. TIMOTHY B FAGAN DMD (PRESIDENT)
- **Authorized official phone:** (229) 985-4674

## Contact information

- **Practice address:** 7 LONGLEAF OFFICE PARK, MOULTRIE, GA 31768
- **Practice address phone:** (229) 985-4674
- **Practice address fax:** (229) 985-0900
- **Mailing address:** PO BOX 160, MOULTRIE, GA 31776
- **Mailing address phone:** (229) 985-4674
- **Mailing address fax:** (229) 985-0900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN011154 | GA | Yes |

## Other

- **Enumeration date:** 08/17/2006
- **Last updated:** 08/22/2020