Healthcare Provider Details

I. General information

NPI: 1114948510
Provider Name (Legal Business Name): MARSHALL DARYL FAGIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6471 TRANSIT RD SUITE #1
EAST AMHERST NY
14051-1427
US

IV. Provider business mailing address

6471 TRANSIT RD SUITE #1
EAST AMHERST NY
14051-1427
US

V. Phone/Fax

Practice location:
  • Phone: 716-633-7070
  • Fax: 716-689-6327
Mailing address:
  • Phone: 716-633-7070
  • Fax: 716-689-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number030795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: