Provider Demographics
NPI:1558305656
Name:FABEL, PHILIP FOREST (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:FOREST
Last Name:FABEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1800
Mailing Address - Country:US
Mailing Address - Phone:763-537-1292
Mailing Address - Fax:763-537-1468
Practice Address - Street 1:4600 LAKE RD
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1800
Practice Address - Country:US
Practice Address - Phone:763-537-1292
Practice Address - Fax:763-537-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice