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General NPI Number Information
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NPI Number | 1184736241
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Entity Type | Organization
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Legal Business Name | GREGORY L. FAUTH, D.D.S.,P.C.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 1940 W GALENA BLVD SUITE 4
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City | AURORA
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State | IL
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Zip | 60506-4319
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Country | US
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Telephone | 630-896-2900
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Fax | 630-896-2968
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Provider Business Mailing Address
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Address Line | 1940 W GALENA BLVD SUITE 4
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City | AURORA
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State | IL
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Zip | 60506-4319
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Country | US
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Telephone | 630-896-2900
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Fax | 630-896-2968
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY L. FAUTH
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Credential | D.D.S.
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Telephone | 630-896-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 211159
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License Number State | IL
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