MEDICARE: PHILIP F FABEL DDS PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558305656	OTHER	MN	TYPE 1 NPI

General Provider Information

NPI Number	:	1922278753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP F FABEL DDS PA

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	:	OWNER
Name	:	DR. PHILIP FOREST FABEL
Credential	:
Telephone Number	:	763-537-1292

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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