Healthcare Provider Details

I. General information

NPI: 1811224397
Provider Name (Legal Business Name): DAVID A FAGET D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 GIRALDA AVE
CORAL GABLES FL
33134-5013
US

IV. Provider business mailing address

260 GIRALDA AVE
CORAL GABLES FL
33134-5013
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-5571
  • Fax: 305-446-7437
Mailing address:
  • Phone: 305-446-5571
  • Fax: 305-446-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN16328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: