Provider Demographics
NPI:1245372945
Name:FAINBARG, GARY MARTIN (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MARTIN
Last Name:FAINBARG
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 1:2441 NO TUSTIN AVE
Mailing Address - Street 2:STE J
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1661
Mailing Address - Country:US
Mailing Address - Phone:714-953-9952
Mailing Address - Fax:714-953-1790
Practice Address - Street 1:2441 NO TUSTIN AVE
Practice Address - Street 2:STE J
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1661
Practice Address - Country:US
Practice Address - Phone:714-953-9952
Practice Address - Fax:714-953-1790
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB1987101OtherDENTI CAL