Individual
DENNIS RULON FAIRBOURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
100 PRISON ROAD, CALIFORNIA STATE PRISON SACRAMENTO, REPRESA, CA 95671
(910) 985-8610
(916) 294-3066
Mailing address
100 PRISON ROAD, CALIFORNIA STATE PRISON SACRAMENTO, REPRESA, CA 95671
(910) 985-8610
(916) 294-3066
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
24664
CA
Other
Enumeration date
12/11/2007
Last updated
12/11/2007
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