Provider Demographics
NPI:1033117379
Name:FABER, RICHARD DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DONALD
Last Name:FABER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:425 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4713
Mailing Address - Country:US
Mailing Address - Phone:631-752-9422
Mailing Address - Fax:631-752-3138
Practice Address - Street 1:425 BROADHOLLOW RD
Practice Address - Street 2:SUITE 125
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4713
Practice Address - Country:US
Practice Address - Phone:631-752-9422
Practice Address - Fax:631-752-3138
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY030056-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics