Individual
DR. JAMES LEO FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0417
Mailing address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0417
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2021026049
MO
122300000X
Dentist
8385285-9922
UT
1223G0001X
General Practice Dentistry
61351
KS
1223G0001X
General Practice Dentistry
DS040267
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103036832 0001
—
PA
Enumeration date
07/28/2011
Last updated
10/28/2024
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