Individual
DR. TIMOTHY B. FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7 LONG LEAF OFFICE PARK, MOULTRIE, GA 31768-6781
(229) 985-4674
Mailing address
PO BOX 160, MOULTRIE, GA 31776-0160
(229) 985-4674
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN011154
GA
Other
Enumeration date
06/24/2008
Last updated
06/24/2008
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