MEDICARE: DR. KEVIN B FADER D.M.D.

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	4235	SC

General Provider Information

NPI Number	:	1740282185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN B FADER D.M.D.

Provider Business Mailing Address
First Line	:	2 CORPUS CHRISTIE PL
Second Line	:	PROFESSIONAL BUILDING STE. 202
City	:	HILTON HEAD
State	:	SC
Zip	:	29928-1700
Country	:	US
Telephone Number	:	843-842-3555
Fax Number	:	843-341-3987

Provider Business Practice Location Address
First Line	:	2 CORPUS CHRISTIE PL
Second Line	:	PROFESSIONAL BUILDING STE. 202
City	:	HILTON HEAD
State	:	SC
Zip	:	29928-1700
Country	:	US
Telephone Number	:	843-842-3555
Fax Number	:	843-341-3987

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/22/2007

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