Provider Demographics
NPI:1144742966
Name:FAIRBANKS, CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:FAIRBANKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 BOYLSTON HWY UNIT 30
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-4103
Mailing Address - Country:US
Mailing Address - Phone:828-891-7999
Mailing Address - Fax:
Practice Address - Street 1:3340 BOYLSTON HWY UNIT 30
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-4103
Practice Address - Country:US
Practice Address - Phone:828-891-7999
Practice Address - Fax:828-891-6002
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10779OtherSTATE OF NC DENTAL EXAMINERS