Provider Demographics
NPI:1487757563
Name:FABER, JOHN S (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:FABER
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 1:5526 WHITE ASH
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-9799
Mailing Address - Country:US
Mailing Address - Phone:517-339-7864
Mailing Address - Fax:
Practice Address - Street 1:5238 W ST JOE HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4085
Practice Address - Country:US
Practice Address - Phone:517-323-1000
Practice Address - Fax:517-886-5566
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016480204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M92400Medicare PIN