| NPI | 1356779995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LEO FAIRBANKS Dentist/Owner 385-275-7400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 8385285-9922) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2013-10-16 |