Provider Demographics
NPI:1679787626
Name:JULIAN H. FAIR 3RD,DMD,PA
Entity type:Organization
Organization Name:JULIAN H. FAIR 3RD,DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAIR 3RD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-564-3446
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:WAGENER
Mailing Address - State:SC
Mailing Address - Zip Code:29164-0800
Mailing Address - Country:US
Mailing Address - Phone:803-564-3446
Mailing Address - Fax:803-564-5254
Practice Address - Street 1:112 LOUIE ST.
Practice Address - Street 2:
Practice Address - City:WAGENER
Practice Address - State:SC
Practice Address - Zip Code:29164-0800
Practice Address - Country:US
Practice Address - Phone:803-564-3446
Practice Address - Fax:803-564-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty