Provider Demographics
NPI:1619186079
Name:FABER, ROBERT KENT (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KENT
Last Name:FABER
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 1:31931 CAMINO CAPISTRANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3239
Mailing Address - Country:US
Mailing Address - Phone:949-493-3376
Mailing Address - Fax:949-493-9595
Practice Address - Street 1:31931 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3239
Practice Address - Country:US
Practice Address - Phone:949-493-3376
Practice Address - Fax:949-493-9595
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice