Provider Demographics
NPI:1023160140
Name:FEGAN, JAMES M (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:FEGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FLOCKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3538
Mailing Address - Country:US
Mailing Address - Phone:908-813-0147
Mailing Address - Fax:
Practice Address - Street 1:2220 BELVIDERE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2116
Practice Address - Country:US
Practice Address - Phone:908-859-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012563001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice