MEDICARE: DR. WILLIAM EUGENE FAULKNER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	753025600	CA

General Provider Information

NPI Number	:	1457541534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EUGENE FAULKNER DDS

Provider Business Mailing Address
First Line	:	5870 CRENSHAW BLVD STE 512
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2449
Country	:	US
Telephone Number	:	323-292-0231
Fax Number	:	323-292-0786

Provider Business Practice Location Address
First Line	:	5870 CRENSHAW BLVD STE 512
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2449
Country	:	US
Telephone Number	:	323-292-0231
Fax Number	:	323-292-0786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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