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Individual

KEVIN JON FAIRHURST

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
900 10TH AVE NW, GREAT FALLS, MT 59404-1747
(406) 761-1365
(406) 403-0418
Mailing address
900 10TH AVE NW, GREAT FALLS, MT 59404-1747
(406) 761-1365
(406) 403-0418

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4144
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2397
MONTANA LICENCE NUMBER
MT
Enumeration date
06/23/2008
Last updated
07/13/2010
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