Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901016480 | MI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2901016480 | MI |
NPI | 1487757563 |
---|---|
Provider Name | Dr. John S Faber |
First Address | Haslett, MI 48840-9799 |
Second Address | Lansing, MI 48917-4085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 28/02/2019 |