Individual
DR. MICHAEL B FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
171 W 10TH ST, CHICAGO HEIGHTS, IL 60411-2072
(708) 755-0433
Mailing address
171 W 10TH ST, CHICAGO HEIGHTS, IL 60411-2072
(708) 755-0433
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IL-1916337
IL
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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