Provider Demographics
NPI:1790210607
Name:MICHAEL FAYNZILBERG DMD PC
Entity Type:Organization
Organization Name:MICHAEL FAYNZILBERG DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYNZILBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-595-0596
Mailing Address - Street 1:990 PARADISE RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1395
Mailing Address - Country:US
Mailing Address - Phone:781-595-0596
Mailing Address - Fax:
Practice Address - Street 1:990 PARADISE RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1395
Practice Address - Country:US
Practice Address - Phone:781-595-0596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty