Individual
DR. KYLE JOSEPH FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2500 W NORTH AVE, CHICAGO, IL 60647-5202
(773) 360-1281
Mailing address
710 W MELROSE ST UNIT 2, CHICAGO, IL 60657-3418
(847) 370-9280
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019031179
IL
Other
Enumeration date
06/19/2017
Last updated
06/19/2017
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