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General NPI Number Information
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NPI Number | 1376336073
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Entity Type | Individual
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Provider Name | CHRISTIAN JOHN FABER
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Gender | Male
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 467 W DEMING PL
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City | CHICAGO
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State | IL
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Zip | 60614-1881
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Country | US
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Telephone | 800-543-7356
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 N HERMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60614-9301
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Country | US
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Telephone | 616-953-8881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1234
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License Number State | IL
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