Provider Demographics
NPI:1184766149
Name:FAINE, ROBERT CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARL
Last Name:FAINE
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 1:2737 77TH AVE SE
Mailing Address - Street 2:#212
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2830
Mailing Address - Country:US
Mailing Address - Phone:206-232-5710
Mailing Address - Fax:206-275-2126
Practice Address - Street 1:2737 77TH AVE SE
Practice Address - Street 2:#212
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2830
Practice Address - Country:US
Practice Address - Phone:206-232-5710
Practice Address - Fax:206-275-2126
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA47001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice