Provider Demographics
NPI:1851908180
Name:FAIBISH, DAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:FAIBISH
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 1:16 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2013
Mailing Address - Country:US
Mailing Address - Phone:617-960-6301
Mailing Address - Fax:
Practice Address - Street 1:81 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6201
Practice Address - Country:US
Practice Address - Phone:617-731-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist