Healthcare Provider Details

I. General information

NPI: 1982772737
Provider Name (Legal Business Name): MARK FAGIN-HUTCHINGS D.D.S., M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARK FAGIN D.D.S., M.S.

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W FIRST ST #15
SANTA ANA CA
92703
US

IV. Provider business mailing address

303 32ND ST
NEWPORT BEACH CA
92663-3127
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-3085
  • Fax: 714-895-1368
Mailing address:
  • Phone: 949-554-4434
  • Fax: 949-566-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1223X0400X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: