DR. MARK CHARLES FAGAN (NPI# 1376562827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376562827 |
| Entity Type | Individual |
| Full Name | DR. MARK CHARLES FAGAN |
| Credential | D.D.S. |
| Practice Address |
1660 Willow St Ste #3 San Jose CA 95125-5101 |
| Practice Telephone | 4082691060 |
| Mailing Telephone | 4082691060 |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
38419 | CA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962449686 | Mark J Fagan | Internal Medicine | 593 Eddy St, Apc 5, Providence, RI 02903-4923 | 2006-06-01 |
| 1588612790 | Mark W Fagan | Dentist | 1061 Harmon Ave, Fort Stewart, GA 31314-5641 | 2006-05-04 |
| Street Address |
1660 WILLOW ST STE #3 |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95125-5101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275536187 | John Stephen Cupples | Dentist | 1660 Willow St, #6, San Jose, CA 95125-5101 | 2005-05-24 |
| 1639793250 | Matthew Michael Malvase | Dentist | 1660 Willow St, San Jose, CA 95125-5101 | 2020-05-29 |
| 1437457553 | Kirk Yen, Dds, Inc. | Clinic/Center | 1660 Willow St, Suite 5, San Jose, CA 95125-5101 | 2011-03-14 |
| 1033239306 | Steven M Toschi | Dentist | 1660 Willow St, Suite I, San Jose, CA 95125-5101 | 2007-03-30 |
| 1174685960 | Charles Rudolph Bocks IIi | Dentist | 1660 Willow St, Suite 7, San Jose, CA 95125-5101 | 2006-12-15 |
| 1730241548 | Charles R Bocks IIi Dds Inc | Dentist | 1660 Willow St, Suite 7, San Jose, CA 95125-5101 | 2006-12-15 |
| 1013971555 | Kirk Kwan Yen | Dentist | 1660 Willow St, 5, San Jose, CA 95125-5101 | 2006-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285245431 | Carmen J. Frank | Marriage & Family Therapist | 913 Willow St., Suite 103, San Jose, CA 95125 | 2020-08-12 |
| 1376197848 | Mariam Samir Abadir | Dentist | 1670 Westwood Dr. Suite K, San Jose, CA 95125 | 2019-08-01 |
| 1750870747 | Gertrud Stojancic | Massage Therapist | 3315 Almaden Expressway, # 27/29, San Jose, CA 95125 | 2018-05-04 |
| 1659809259 | Edward Escoto | Assistant Behavior Analyst | 2075 Lincoln Ave Ste D, San Jose, CA 95125 | 2017-05-25 |
| 1104288422 | Kristin Ann Dessau | Counselor | 1261 Lincoln Avenue, Suite 202, San Jose, CA 95125 | 2016-03-25 |
| 1275964488 | Indian Health Center of Santa Clara Valley | Clinic/Center | 1685 Westwood Dr Ste 1, San Jose, CA 95125 | 2013-12-13 |
| 1598042905 | Walgreens | Exclusive Provider Organization | 2585 Almaden Road, San Jose, CA 95125 | 2011-11-14 |
| 1881981488 | Kevin Jia-chian Yen | Dentist | 1660 Willow St Ste 5, San Jose, CA 95125 | 2011-07-02 |
| 1699093724 | Lokahi Acupuncture, Inc. | Acupuncturist | 1688 Willow Street, Suite B, San Jose, CA 95125 | 2010-05-13 |
| 1538482468 | Mark Lucius Yoslow | Psychologist | 970 Minnesota Avenue, San Jose, CA 95125 | 2010-03-06 |
| Find all providers in zip 95125 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225641293 | Richard T. Kao, Dds, Phd - Dental Corp. | Dentist | 1660 Willow St Ste 3, San Jose, CA 95125-5101 | 2020-08-28 |
| 1518331123 | Prasit Aranyarachkul, Dds, Inc | Dentist | 3996 S Bascom Ave Ste 6, San Jose, CA 95124-2663 | 2015-11-19 |
| 1659713766 | Rana Baroudi, Dmd, Ms Dental Corporation | Dentist | 3535 Ross Ave Ste 302, San Jose, CA 95124-3038 | 2013-07-18 |
| 1114102357 | Timothy W. Gifford | Dentist | 5595 Winfield Blvd Ste 208, San Jose, CA 95123-1220 | 2008-01-07 |
| 1609074988 | Donald W Boyle Dds Inc | Dentist | 3996 S Bascom Ave, San Jose, CA 95124-2663 | 2007-07-06 |
| 1750590048 | Binh Duong Nguyen | Dentist | 2351 Mckee Rd, Suite B, San Jose, CA 95116-1624 | 2007-05-22 |
| 1154549988 | Norman Dartt Fuller IIi | Dentist | 1701 Lundy Ave Ste 150, San Jose, CA 95131-1858 | 2007-04-24 |
| 1861538118 | Siamak Madani | Dentist | 4155 Moorpark Ave Ste 18, San Jose, CA 95117-1714 | 2007-01-30 |
| 1275680530 | Christine M. Hayashi | Dentist | 2000 Forest Ave Ste A, San Jose, CA 95128-4831 | 2007-01-05 |
| 1700976149 | Niloofar Zarkesh | Dentist | 100 Oconnor Dr Ste 10, San Jose, CA 95128-1638 | 2006-10-14 |
| Find all providers in SAN JOSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.