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Organization
JONATHAN M. FAIRBANKS, D.D.S., PLLC
Active
Organization
JONATHAN M. FAIRBANKS, D.D.S., PLLC
Active
Other names
Pullman Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN MARVIN FAIRBANKS DDS (DENTIST)
(509) 332-7463
Entity
Organization
Contact information
Practice address
1410 SE BISHOP BLVD # 1S, PULLMAN, WA 99163-5419
(509) 334-6700
(509) 334-9239
Mailing address
1410 SE BISHOP BLVD # 1S, PULLMAN, WA 99163-5419
(509) 334-6700
(509) 334-9239
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00008587
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5033295
—
WA
Enumeration date
04/15/2010
Last updated
03/16/2012
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