Provider Demographics
NPI:1679744585
Name:FABER, NATHAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:M
Last Name:FABER
Suffix:
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 1:2N FLOOR INTERSEA MALL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DUTCH HARBOR
Mailing Address - State:AK
Mailing Address - Zip Code:99692
Mailing Address - Country:US
Mailing Address - Phone:907-581-3828
Mailing Address - Fax:907-581-6494
Practice Address - Street 1:2N FLOOR INTERSEA MALL
Practice Address - Street 2:SUITE 201
Practice Address - City:DUTCH HARBOR
Practice Address - State:AK
Practice Address - Zip Code:99692
Practice Address - Country:US
Practice Address - Phone:907-581-3828
Practice Address - Fax:907-581-6494
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice