Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 030795 | NY |
NPI | 1114948510 |
---|---|
Provider Name | Dr. Marshall Daryl Fagin |
First Address | East Amherst, NY 14051-1427 |
Second Address | East Amherst, NY 14051-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 23/10/2012 |