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General NPI Number Information
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NPI Number | 1780701128
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Entity Type | Individual
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Provider Name | FABIAN GREGORY HOSEIN D.D.S, M.S.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 3306 W CHARTWELL RD
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City | PEORIA
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State | IL
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Zip | 61614-2322
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Country | US
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Telephone | 309-690-0011
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Fax | 309-690-0022
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Provider Business Mailing Address
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Address Line | 3306 W CHARTWELL RD
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City | PEORIA
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State | IL
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Zip | 61614-2322
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Country | US
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Telephone | 309-690-0011
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Fax | 309-690-0022
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 21461
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19027263
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 009566
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021002221
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License Number State | IL
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