Provider Demographics
NPI:1811997893
Name:FAYNOR, MARIE C (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:C
Last Name:FAYNOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 W PURCHASE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1002
Mailing Address - Country:US
Mailing Address - Phone:203-405-1242
Mailing Address - Fax:
Practice Address - Street 1:42 W PURCHASE RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1002
Practice Address - Country:US
Practice Address - Phone:203-405-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069151223D0001X
CT69151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002069153Medicaid