Provider Demographics
NPI:1306187026
Name:FAULK, BRENDA J (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:FAULK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WALKER AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-486-2603
Mailing Address - Fax:410-486-2605
Practice Address - Street 1:31 WALKER AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-486-2603
Practice Address - Fax:410-486-2605
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist