# JEREMY L FAIRBOURN DDS, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396081576
- **Authorized official:** JEREMY LYNN FAIRBOURN D.D.S. (MEMBER)
- **Authorized official phone:** (502) 633-3900

## Contact information

- **Practice address:** 207 ALPINE DR, SHELBYVILLE, KY 40065-8881
- **Practice address phone:** (502) 633-3900
- **Mailing address:** 207 ALPINE DR, SHELBYVILLE, KY 40065-8881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 9270 | KY | Yes |

## Other

- **Enumeration date:** 12/17/2012
- **Last updated:** 12/17/2012