Provider Demographics
NPI:1396046942
Name:DR. GERALD L. FAIRCHILD, PSC
Entity type:Organization
Organization Name:DR. GERALD L. FAIRCHILD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-780-0375
Mailing Address - Street 1:276 KROGER CTR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8894
Mailing Address - Country:US
Mailing Address - Phone:606-780-0375
Mailing Address - Fax:606-784-1162
Practice Address - Street 1:276 KROGER CTR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8894
Practice Address - Country:US
Practice Address - Phone:606-780-0375
Practice Address - Fax:606-784-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty