Healthcare Provider Details

I. General information

NPI: 1982520672
Provider Name (Legal Business Name): AARON FAULK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W LAKE ST
CHICAGO IL
60644-2342
US

IV. Provider business mailing address

1809 W SUPERIOR ST APT 1F
CHICAGO IL
60622-5674
US

V. Phone/Fax

Practice location:
  • Phone: 773-295-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037265
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: