Healthcare Provider Details

I. General information

NPI: 1407489610
Provider Name (Legal Business Name): FAGIN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2020
Last Update Date: 02/16/2020
Certification Date: 02/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 N FRESNO ST STE 203A
FRESNO CA
93720-2957
US

IV. Provider business mailing address

11925 N RIDGEWAY DR
FRESNO CA
93730-7075
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-0966
  • Fax: 559-435-5851
Mailing address:
  • Phone: 949-554-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK FAGIN-HUTCHINGS
Title or Position: OWNER/PRESIDENT
Credential: D.D.S., M.S.
Phone: 949-554-4434