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General NPI Number Information
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NPI Number | 1841375953
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Entity Type | Organization
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Legal Business Name | CHRIS FAGAN DDS PLLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 06/30/2016
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Provider Practice Location Address
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Address Line | 423 N VAN BUREN ST
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City | ENID
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State | OK
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Zip | 73703-4454
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Country | US
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Telephone | 580-233-0043
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Fax | 580-233-8571
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Provider Business Mailing Address
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Address Line | 423 N VAN BUREN ST
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City | ENID
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State | OK
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Zip | 73703-4454
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Country | US
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Telephone | 580-233-0043
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Fax | 580-233-8571
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. CHRIS P FAGAN
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Credential | DDS, PLLC
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Telephone | 580-233-0043
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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 | 6280
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License Number State | OK
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