Provider Demographics
NPI:1689750572
Name:FAIR, JULIAN HARRISON III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:HARRISON
Last Name:FAIR
Suffix:III
Gender:M
Credentials:DMD
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Mailing Address - Street 1:JULIAN H. FAIR 111,DMD,P.A. , 112 LOUIE STREET
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:WAGENER
Mailing Address - State:SC
Mailing Address - Zip Code:29164
Mailing Address - Country:US
Mailing Address - Phone:803-564-3446
Mailing Address - Fax:803-564-5254
Practice Address - Street 1:JULIAN H. FAIR 111,DMD,P.A. , 112 LOUIE STREET
Practice Address - Street 2:112 LOUIE STREET
Practice Address - City:WAGENER
Practice Address - State:SC
Practice Address - Zip Code:29164
Practice Address - Country:US
Practice Address - Phone:803-564-3446
Practice Address - Fax:803-564-5254
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
SC21731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice