Healthcare Provider Details

I. General information

NPI: 1811684129
Provider Name (Legal Business Name): THOMAS G. FAIVER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E LAKE LANSING RD
EAST LANSING MI
48823-7413
US

IV. Provider business mailing address

1350 E LAKE LANSING RD
EAST LANSING MI
48823-7413
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-7222
  • Fax: 517-351-0030
Mailing address:
  • Phone: 517-351-7222
  • Fax: 517-351-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS G. FAIVER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 517-351-7222