MEDICARE: DR. PHILIP FOREST FABEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7299	MN

General Provider Information

NPI Number	:	1558305656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP FOREST FABEL DDS

Provider Business Mailing Address
First Line	:	4600 LAKE RD
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-1800
Country	:	US
Telephone Number	:	763-537-1292
Fax Number	:	763-537-1468

Provider Business Practice Location Address
First Line	:	4600 LAKE RD
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-1800
Country	:	US
Telephone Number	:	763-537-1292
Fax Number	:	763-537-1468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	03/07/2008

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