Provider Demographics
NPI:1568693240
Name:FAIRBANKS, TODD PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:PAUL
Last Name:FAIRBANKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF WASHINGTON ORAL SURGERY DEPT
Mailing Address - Street 2:BOX 357134, 1959 NE PACIFIC ST.
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7134
Mailing Address - Country:US
Mailing Address - Phone:206-543-7722
Mailing Address - Fax:206-685-7222
Practice Address - Street 1:UNIVERSITY OF WASHINGTON ORAL SURGERY DEPT
Practice Address - Street 2:BOX 357134, 1959 NE PACIFIC ST.
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7134
Practice Address - Country:US
Practice Address - Phone:206-543-7722
Practice Address - Fax:206-685-7222
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR 600960661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery