Healthcare Provider Details

I. General information

NPI: 1740702935
Provider Name (Legal Business Name): ASHLEY D FAGAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 1ST ST NE STE 101
WASHINGTON DC
20002-5859
US

IV. Provider business mailing address

1050 1ST ST NE STE 101
WASHINGTON DC
20002-5859
US

V. Phone/Fax

Practice location:
  • Phone: 202-642-9229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN1001743
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: