Provider Demographics
NPI:1689880312
Name:FAHRINGER, DONALD GORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GORDAN
Last Name:FAHRINGER
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 1:1540 STATE ROUTE 138 STE 101 BLDG 1
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3766
Mailing Address - Country:US
Mailing Address - Phone:732-280-0700
Mailing Address - Fax:732-280-8440
Practice Address - Street 1:1540 STATE ROUTE 138 STE 101 BLDG 1
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3766
Practice Address - Country:US
Practice Address - Phone:732-280-0700
Practice Address - Fax:732-280-8440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013225001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics