Healthcare Provider Details

I. General information

NPI: 1023479201
Provider Name (Legal Business Name): KOURTNI FABER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8385 DIVISION RD
WHITE CITY OR
97503
US

IV. Provider business mailing address

906 ROYAL CT
MEDFORD OR
97504-6139
US

V. Phone/Fax

Practice location:
  • Phone: 541-826-5853
  • Fax: 541-826-5843
Mailing address:
  • Phone: 541-414-0519
  • Fax: 541-842-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH6234
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: