Provider Demographics
NPI:1467566166
Name:FAHSBENDER, JOHN JULIUS III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JULIUS
Last Name:FAHSBENDER
Suffix:III
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 1:28 KILMER DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-3830
Mailing Address - Country:US
Mailing Address - Phone:908-874-0524
Mailing Address - Fax:
Practice Address - Street 1:101 UNION AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1039
Practice Address - Country:US
Practice Address - Phone:732-356-1313
Practice Address - Fax:732-356-1092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ112561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice