Randy Fagan Dds, PC

NPI #1083888036 in Broken Arrow, Oklahoma

Provider Information

NPI Number: 1083888036
Entity Type: Organization
Organization Name: Randy Fagan Dds, PC
Primary Specialty: Dentist
Enumeration Date: Apr 21, 2008
Last Updated: Apr 21, 2008

Practice Location

Address: 2221 W WASHINGTON ST
City: Broken Arrow
State: Oklahoma
ZIP Code: 74012-6726
Phone: (918) 455-6406

Authorized Official

Name: DR. RANDY JAMES FAGAN, D.D.S.
Title: PRESIDENT
Phone: (918) 455-6406

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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