Fairbanks, Connor

Fairbanks, Connor is an individual health care provider with primary practice located at 921 S 8Th Ave Stop 8088 , Pocatello ID 83209-0002. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Fairbanks, Connor can be contacted via phone (208) 282-6000.

Contact Information

Primary practice address
921 S 8Th Ave Stop 8088 Pocatello ID 83209-0002
Phone: (208) 282-6000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D-4836 Idaho

Profile Details

NPI number 1952822686
LBN Legal business name Fairbanks, Connor
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2017
Last updated Jul 3rd, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952822686 NPPES
Idaho Other D-4836 IDAHO STATE BOARD OF DENTISTRY (DENTAL LICENSE)

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