Tim R Fagan, DDS, MS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

4227 Issued in OK

Practice address

1201 N Stonewall Ave
Oklahoma City, OK 73117-1214

Phone

(405) 271-5444

NPI assigned

Jun 8, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563926400000",
    "number": "1477557452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 N VAN BUREN ST",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737034454",
            "telephone_number": "580-233-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N STONEWALL AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731171214",
            "telephone_number": "405-271-5444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "423 N Van Buren St",
            "address_purpose": "LOCATION",
            "city": "Enid",
            "state": "OK",
            "postal_code": "737034454",
            "country_code": "US",
            "telephone_number": "580-233-0043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "TIM",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2019-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OK",
            "license": "4227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modebola Fadare
• Chase Faddis
• Reanna Gabrielle Fadel
• Femi Benjamin Fafunmi, MS, LPC
• Stacy Louise Fagan, P.A.
• Lillian Kay Fagg
• Jinnat Fahmida, MS,RDN/LD
• Salar Maysam Faiazi, M.D.
• Don Turon Fails
• Robert Brian Fails, M.D.

• Pediatric Dentistry in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Pediatric Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.