Provider Demographics
NPI:1992897144
Name:FAUST, FREDERICK ROY (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ROY
Last Name:FAUST
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 1:111 W 1ST ST STE 915
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1106
Mailing Address - Country:US
Mailing Address - Phone:937-222-9413
Mailing Address - Fax:
Practice Address - Street 1:111 W 1ST ST STE 915
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1106
Practice Address - Country:US
Practice Address - Phone:937-222-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-012448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist