Individual
DR. HENRY A FASTEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5042 DORSEY HALL DR, STE 102, ELLICOTT CITY, MD 21042
(410) 964-3020
(410) 964-3021
Mailing address
14700 MUSTANG PATH, GLENWOOD, MD 21738
(410) 442-2526
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6680
MD
Other
Enumeration date
08/12/2006
Last updated
07/08/2007
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