Provider Demographics
NPI:1417152166
Name:FAIN, WILLIAM G (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:FAIN
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 1:620 PERIMETER DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4125
Mailing Address - Country:US
Mailing Address - Phone:859-269-5391
Mailing Address - Fax:
Practice Address - Street 1:620 PERIMETER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4125
Practice Address - Country:US
Practice Address - Phone:859-269-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist