Organization
RANDY FAGAN DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY JAMES FAGAN D.D.S. (PRESIDENT)
(918) 455-6406
Entity
Organization
Contact information
Practice address
2221 W WASHINGTON ST, BROKEN ARROW, OK 74012-6726
(918) 455-6406
(918) 455-1856
Mailing address
2221 W WASHINGTON ST, BROKEN ARROW, OK 74012-6726
(918) 455-6406
(918) 455-1856
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5318
OK
Other
Enumeration date
04/21/2008
Last updated
04/21/2008
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