Individual
DR. MARK W FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10205 N RIVA RIDGE LOOP, FORT DRUM, NY 13602-5457
(315) 772-5088
Mailing address
120 MILL CREEK LN, SACKETS HARBOR, NY 13685-9744
(915) 841-8661
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
11964
MD
Other
Enumeration date
05/04/2006
Last updated
04/27/2026
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