Healthcare Provider Details

I. General information

NPI: 1164474540
Provider Name (Legal Business Name): JEFFREY B FAYCURRY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 FIVE POINTS DR SUITE 103
AUBURN HILLS MI
48326-2379
US

IV. Provider business mailing address

3271 FIVE POINTS DR SUITE 103
AUBURN HILLS MI
48326-2379
US

V. Phone/Fax

Practice location:
  • Phone: 248-373-8110
  • Fax: 248-373-7672
Mailing address:
  • Phone: 248-373-8110
  • Fax: 248-373-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15435
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: