Provider Demographics
NPI:1831268572
Name:FAULKNER, DENNIS R (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 BOGLE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2873
Mailing Address - Country:US
Mailing Address - Phone:606-679-7353
Mailing Address - Fax:
Practice Address - Street 1:347 BOGLE ST STE A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2873
Practice Address - Country:US
Practice Address - Phone:606-679-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23151207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7423OtherMEDICARE GROUP
KY64231517Medicaid
7423OtherMEDICARE GROUP
KY64231517Medicaid