Individual
PAUL FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
601 NW 3RD ST, PRINEVILLE, OR 97754
(541) 447-4888
Mailing address
601 NW 3RD ST, PRINEVILLE, OR 97754-1717
(541) 447-4888
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10255
OR
Other
Enumeration date
06/22/2015
Last updated
02/28/2017
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