Provider Demographics
NPI:1003969940
Name:FAULK DENTAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:FAULK DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-486-2603
Mailing Address - Street 1:31 WALKER AVENUE, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-486-2603
Mailing Address - Fax:410-486-2605
Practice Address - Street 1:31 WALKER AVENUE, SUITE 110
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-486-2603
Practice Address - Fax:410-486-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty