Provider Demographics
NPI:1073878005
Name:FAIST, KEVIN JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:FAIST
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 1:1815 VIA EL PRADO STE 200
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5725
Mailing Address - Country:US
Mailing Address - Phone:310-316-4477
Mailing Address - Fax:310-316-4475
Practice Address - Street 1:1815 VIA EL PRADO STE 200
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5725
Practice Address - Country:US
Practice Address - Phone:310-316-4477
Practice Address - Fax:310-316-4475
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190291021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice