Healthcare Provider Details

I. General information

NPI: 1467198382
Provider Name (Legal Business Name): BETH ANN FABER DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W GRAND RIVER AVE STE C
WILLIAMSTON MI
48895-1343
US

IV. Provider business mailing address

425 W GRAND RIVER AVE STE C
WILLIAMSTON MI
48895-1343
US

V. Phone/Fax

Practice location:
  • Phone: 517-655-1500
  • Fax: 517-655-8560
Mailing address:
  • Phone: 517-655-1500
  • Fax:

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: BETH ANN FABER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 517-655-1500