Provider Demographics
NPI:1922278753
Name:PHILIP F FABEL DDS PA
Entity Type:Organization
Organization Name:PHILIP F FABEL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:FOREST
Authorized Official - Last Name:FABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-537-1292
Mailing Address - Street 1:4600 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1800
Mailing Address - Country:US
Mailing Address - Phone:763-537-1292
Mailing Address - Fax:763-537-1468
Practice Address - Street 1:4600 LAKE RD
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1800
Practice Address - Country:US
Practice Address - Phone:763-537-1292
Practice Address - Fax:763-537-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1558305656OtherTYPE 1 NPI