Fagan, Mark W

Fagan, Mark W is an individual health care provider with primary practice located at 10205 N Riva Ridge Loop , Fort Drum NY 13602-5457. He recently has only one registered license in Dental Providers / Prosthodontics, which is considered as his primary health care specialty. Fagan, Mark W can be contacted via phone (315) 772-5088.

Contact Information

Primary practice address
10205 N Riva Ridge Loop Fort Drum NY 13602-5457
Phone: (315) 772-5088
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Prosthodontics 1223P0700X 11964 Maryland

Profile Details

NPI number 1588612790
LBN Legal business name Fagan, Mark W
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Jun 30th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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