Provider Demographics
NPI:1285804450
Name:FAUBLE, CURTIS D (DDS)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:D
Last Name:FAUBLE
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 1:4561 MAINE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305
Mailing Address - Country:US
Mailing Address - Phone:217-228-1085
Mailing Address - Fax:217-228-1089
Practice Address - Street 1:4561 MAINE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305
Practice Address - Country:US
Practice Address - Phone:217-228-1085
Practice Address - Fax:217-228-1089
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004529Medicaid