Provider Demographics
NPI:1053471862
Name:FAULKNER, DAVIN GEO (DMD)
Entity Type:Individual
Prefix:MR
First Name:DAVIN
Middle Name:GEO
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 1325 N STE 125
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8176
Mailing Address - Country:US
Mailing Address - Phone:435-586-3884
Mailing Address - Fax:435-586-9671
Practice Address - Street 1:110W 1325N #125
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-586-3884
Practice Address - Fax:435-586-9671
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT626318499211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
205818955Medicare UPIN