1700962941 NPI number — DR. FORREST HUGHES FAULCONER DDS

Table of content: DR. FORREST HUGHES FAULCONER DDS (NPI 1700962941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700962941 NPI number — DR. FORREST HUGHES FAULCONER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAULCONER
Provider First Name:
FORREST
Provider Middle Name:
HUGHES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700962941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3505 AUSTIN BLUFFS PARKWAY
Provider Second Line Business Mailing Address:
SUITE #315
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-576-8632
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 AUSTIN BLUFFS PARKWAY
Provider Second Line Business Practice Location Address:
SUITE #315
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-598-7862
Provider Business Practice Location Address Fax Number:
719-531-6006
Provider Enumeration Date:
10/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  C03369 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)