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Individual

RICHARD AGNEW FAGIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
235 N SAN MATEO DR, SUITE 600, SAN MATEO, CA 94401
(650) 342-0213
(650) 342-0636
Mailing address
235 N SAN MATEO DR, SUITE 600, SAN MATEO, CA 94401
(650) 342-0213
(650) 342-0636

Taxonomy

Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
D20691
CA

Other

Enumeration date
11/22/2006
Last updated
07/08/2007
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