MEDICARE: DR. WILLIAM G. FAIN, P.S.C.

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	7106	KY

General Provider Information

NPI Number	:	1669562013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. WILLIAM G. FAIN, P.S.C.

Provider Business Mailing Address
First Line	:	620 PERIMETER DR
Second Line	:	SUITE 206
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4125
Country	:	US
Telephone Number	:	859-269-5391
Fax Number	:	859-266-7701

Provider Business Practice Location Address
First Line	:	620 PERIMETER DR
Second Line	:	SUITE 206
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4125
Country	:	US
Telephone Number	:	859-269-5391
Fax Number	:	859-266-7701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM G FAIN
Credential	:	D.M.D.
Telephone Number	:	859-269-5391

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	07/23/2013

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