Healthcare Provider Details

I. General information

NPI: 1770814261
Provider Name (Legal Business Name): THOMAS FAERBER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL CT
CLARKSVILLE TN
37043-4602
US

IV. Provider business mailing address

118 MEDICAL CT
CLARKSVILLE TN
37043-4602
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-6322
  • Fax:
Mailing address:
  • Phone: 931-645-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS006917
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: