Provider Demographics
NPI:1689620155
Name:FAIRBURN, STEVAN CRAIG (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVAN
Middle Name:CRAIG
Last Name:FAIRBURN
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 HELEN KELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2983
Mailing Address - Country:US
Mailing Address - Phone:205-556-2323
Mailing Address - Fax:205-556-2341
Practice Address - Street 1:651 HELEN KELLER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2983
Practice Address - Country:US
Practice Address - Phone:205-556-2323
Practice Address - Fax:205-556-2341
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5144 (DENTAL)1223S0112X
AL5144204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery