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General NPI Number Information
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NPI Number | 1760553614
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Entity Type | Individual
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Provider Name | RONALD J FAGAN DDS
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1128 W MAIN ST
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City | INVERNESS
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State | FL
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Zip | 34450
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Country | US
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Telephone | 352-344-2275
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Fax | 352-344-1416
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Provider Business Mailing Address
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Address Line | 10662 HALLS RIVER RD
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City | HOMOSASSA
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State | FL
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Zip | 34448
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Country | US
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Telephone | 352-621-3031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN11969
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License Number State | FL
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