Provider Demographics
NPI:1992844104
Name:FAETH, MARY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LEE
Last Name:FAETH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 COUNTY LINE RD W
Mailing Address - Street 2:SUITE #100
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7080
Mailing Address - Country:US
Mailing Address - Phone:614-898-0440
Mailing Address - Fax:
Practice Address - Street 1:484 COUNTY LINE RD W
Practice Address - Street 2:SUITE #100
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7080
Practice Address - Country:US
Practice Address - Phone:614-898-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice