Provider Demographics
NPI:1942204201
Name:FAUGHT, MARK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:FAUGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 ENTERPRISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANTOUL
Mailing Address - State:IL
Mailing Address - Zip Code:61866-3689
Mailing Address - Country:US
Mailing Address - Phone:217-359-9900
Mailing Address - Fax:217-892-8868
Practice Address - Street 1:730 ENTERPRISE DRIVE
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-3689
Practice Address - Country:US
Practice Address - Phone:217-359-9900
Practice Address - Fax:217-892-8869
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2015-02-27
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
IL0190191811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice