Provider Demographics
NPI:1376336073
Name:FABER, CHRISTIAN JOHN
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOHN
Last Name:FABER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 N HERMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-9301
Mailing Address - Country:US
Mailing Address - Phone:616-953-8881
Mailing Address - Fax:
Practice Address - Street 1:467 W DEMING PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1881
Practice Address - Country:US
Practice Address - Phone:800-543-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry