Provider Demographics
NPI:1538394846
Name:FAERBER, DAVID EDWARDS (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARDS
Last Name:FAERBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 E 255 S
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4496
Mailing Address - Country:US
Mailing Address - Phone:801-544-9593
Mailing Address - Fax:
Practice Address - Street 1:3672 W SOUTH JORDAN PKWY # D104
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7171
Practice Address - Country:US
Practice Address - Phone:801-878-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7040150-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice