Healthcare Provider Details

I. General information

NPI: 1275504953
Provider Name (Legal Business Name): JOHN S FAERBER DDS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 W 83RD ST SUITE 245
PRAIRIE VILLAGE KS
66208-5300
US

IV. Provider business mailing address

4121 W 83RD STREET SUITE 245
PRAIRIE VILLAGE KS
66208
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-6694
  • Fax: 913-648-6697
Mailing address:
  • Phone: 913-648-6694
  • Fax: 913-648-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5880
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: