Active NPI
Andrew Fagin
- General Practice Dentistry
- Bradenton, FL
National Provider Identifier
1447780770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN22597
- Practice address
- 109 44TH Ave E Ste 200
Bradenton, FL 34203-3639 - Phone
- (941) 357-1292
- NPI assigned
- Jun 19, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN22597 | FL | Primary |
Addresses
Primary practice location
109 44TH Ave E Ste 200
Bradenton, FL 34203-3639
Mailing address
133 Bella Vista Ter Unit D
North Venice, FL 34275-6764
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN22597 | FL | MD | General Practice Dentistry |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497830400000",
"number": "1447780770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 BELLA VISTA TER UNIT D",
"city": "NORTH VENICE",
"state": "FL",
"postal_code": "342756764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 44TH AVE E STE 200",
"city": "BRADENTON",
"state": "FL",
"postal_code": "342033639",
"telephone_number": "941-357-1292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGIN",
"first_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-19",
"last_updated": "2017-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN22597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradenton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.