Provider Demographics
NPI:1902949209
Name:FAHRBACH, DAVID CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:FAHRBACH
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 1:2020 N WOODLAWN
Mailing Address - Street 2:SUITE 570
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1885
Mailing Address - Country:US
Mailing Address - Phone:316-652-7430
Mailing Address - Fax:316-652-0677
Practice Address - Street 1:2020 N WOODLAWN
Practice Address - Street 2:SUITE 570
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1885
Practice Address - Country:US
Practice Address - Phone:316-652-7430
Practice Address - Fax:316-652-0677
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist