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General NPI Number Information
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NPI Number | 1750554614
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Entity Type | Organization
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Legal Business Name | NATHAN M. FABER DMD PC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 413 E REZANOF DR
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City | KODIAK
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State | AK
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Zip | 99615-6367
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Country | US
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Telephone | 907-486-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 413 E REZANOF DR
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City | KODIAK
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State | AK
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Zip | 99615-6367
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Country | US
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Telephone | 907-486-3257
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATHAN MORGAN FABER
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Credential | DMD
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Telephone | 907-486-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1179
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License Number State | AK
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