Provider Demographics
NPI:1457541534
Name:FAULKNER, WILLIAM EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:FAULKNER
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 1:5870 CRENSHAW BLVD STE 512
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2449
Mailing Address - Country:US
Mailing Address - Phone:323-292-0231
Mailing Address - Fax:323-292-0786
Practice Address - Street 1:5870 CRENSHAW BLVD STE 512
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2449
Practice Address - Country:US
Practice Address - Phone:323-292-0231
Practice Address - Fax:323-292-0786
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7530256001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice