Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 030056-1 | NY |
NPI | 1033117379 |
---|---|
Provider Name | Dr. Richard Donald Faber |
First Address | Melville, NY 11747-4713 |
Second Address | Melville, NY 11747-4713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 08/07/2007 |