Provider Demographics
NPI:1548593437
Name:FAULKNER, MATHUE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATHUE
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 GARLAND RD APT 921
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3974
Mailing Address - Country:US
Mailing Address - Phone:801-808-4756
Mailing Address - Fax:
Practice Address - Street 1:9191 GARLAND RD APT 921
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3974
Practice Address - Country:US
Practice Address - Phone:801-808-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL189081223X0400X
TX277381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics