Individual
DR. RONALD EDWARD FAIRFAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
14 E. ELM ST., HAILEY, ID 83333
(208) 788-0048
(208) 788-8575
Mailing address
PO BOX 3150, HAILEY, ID 83333-3150
(208) 788-0048
(208) 788-8575
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3221
ID
Other
Enumeration date
09/22/2006
Last updated
07/08/2007
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