Provider Demographics
NPI:1831112994
Name:FAUBL, JOHN R
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:FAUBL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11613 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6956
Mailing Address - Country:US
Mailing Address - Phone:847-515-2400
Mailing Address - Fax:847-515-2903
Practice Address - Street 1:11613 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6956
Practice Address - Country:US
Practice Address - Phone:847-515-2400
Practice Address - Fax:847-515-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0242111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice