Provider Demographics
NPI:1255437265
Name:FARIS, JOHN WILSON III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILSON
Last Name:FARIS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3821 ATLANTIC AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3534
Mailing Address - Country:US
Mailing Address - Phone:562-424-8666
Mailing Address - Fax:562-426-6189
Practice Address - Street 1:3821 ATLANTIC AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3534
Practice Address - Country:US
Practice Address - Phone:562-424-8666
Practice Address - Fax:562-426-6189
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA213081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice