Individual
DR. RANDY J FAGAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
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
02/14/2006
Last updated
07/08/2007
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