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Organization
JEREMY L FAIRBOURN DDS, PLLC
Active
Organization
JEREMY L FAIRBOURN DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY LYNN FAIRBOURN D.D.S. (MEMBER)
(502) 633-3900
Entity
Organization
Contact information
Practice address
207 ALPINE DR, SHELBYVILLE, KY 40065-8881
(502) 633-3900
Mailing address
207 ALPINE DR, SHELBYVILLE, KY 40065-8881
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9270
KY
Other
Enumeration date
12/17/2012
Last updated
12/17/2012
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