Provider Demographics
NPI:1215958608
Name:FAVERO, MICHAEL REX (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:REX
Last Name:FAVERO
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 1:2237 PARK TOWNE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-0417
Mailing Address - Country:US
Mailing Address - Phone:916-487-9100
Mailing Address - Fax:916-488-6757
Practice Address - Street 1:2237 PARK TOWNE CIRCLE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0417
Practice Address - Country:US
Practice Address - Phone:916-487-9100
Practice Address - Fax:916-488-6757
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist