Provider Demographics
NPI:1417560657
Name:ALAN R. FABER JR. DDS PC
Entity Type:Organization
Organization Name:ALAN R. FABER JR. DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FABER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-822-8680
Mailing Address - Street 1:8191 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2610
Mailing Address - Country:US
Mailing Address - Phone:313-822-8680
Mailing Address - Fax:313-822-8682
Practice Address - Street 1:8191 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2610
Practice Address - Country:US
Practice Address - Phone:313-822-8680
Practice Address - Fax:313-822-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental