Provider Demographics
NPI:1538234695
Name:FAGIN, RICHARD AGNEW (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:AGNEW
Last Name:FAGIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:235 N SAN MATEO DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-342-0213
Mailing Address - Fax:650-342-0636
Practice Address - Street 1:235 N SAN MATEO DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-342-0213
Practice Address - Fax:650-342-0636
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAD20691204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery