Provider Demographics
NPI:1205901071
Name:FAULKNER, WAYNE L (DDS PA)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:L
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 VENTURE DRIVE
Mailing Address - Street 2:STE 102
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-907-1199
Mailing Address - Fax:941-907-6611
Practice Address - Street 1:6320 VENTURE DRIVE
Practice Address - Street 2:STE 102
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-907-1199
Practice Address - Fax:941-907-6611
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBF74526481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice