Individual
DR. MARK CHARLES FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1660 WILLOW ST, STE #3, SAN JOSE, CA 95125-5101
(408) 269-1060
Mailing address
1660 WILLOW ST, STE #3, SAN JOSE, CA 95125-5101
(408) 269-1060
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
38419
CA
Other
Enumeration date
07/18/2006
Last updated
07/08/2007
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