MEDICARE: DR. CARL COLLIN FAIRCHILD PHARMD, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DD3476	NM
2	1223G0001X	General Practice Dentistry	D7462	AZ

General Provider Information

NPI Number	:	1912195462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL COLLIN FAIRCHILD PHARMD, DDS

Provider Business Mailing Address
First Line	:	2880 E GERMANN RD
Second Line	:	SUITE 13
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1410
Country	:	US
Telephone Number	:	480-280-0669
Fax Number	:	480-821-5111

Provider Business Practice Location Address
First Line	:	3569 ZAFARANO DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2618
Country	:	US
Telephone Number	:	480-280-0669
Fax Number	:	480-821-5111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	03/21/2012

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