Provider Demographics
NPI:1679730949
Name:FAITH, PETER ERNEST (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ERNEST
Last Name:FAITH
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 1:1645 IRVING PARK RD
Mailing Address - Street 2:#202
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133
Mailing Address - Country:US
Mailing Address - Phone:630-837-5156
Mailing Address - Fax:630-837-5156
Practice Address - Street 1:1645 IRVING PARK RD
Practice Address - Street 2:#202
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133
Practice Address - Country:US
Practice Address - Phone:630-837-5156
Practice Address - Fax:630-837-5156
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023574122300000X
IL0210018421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1005299Medicaid