Organization
TIMOTHY B FAGAN DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY B FAGAN DMD (PRESIDENT)
(229) 985-4674
Entity
Organization
Contact information
Practice address
7 LONGLEAF OFFICE PARK, MOULTRIE, GA 31768
(229) 985-4674
(229) 985-0900
Mailing address
PO BOX 160, MOULTRIE, GA 31776
(229) 985-4674
(229) 985-0900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN011154
GA
Other
Enumeration date
08/17/2006
Last updated
08/22/2020
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