Healthcare Provider Details

I. General information

NPI: 1588852826
Provider Name (Legal Business Name): BRANDON W. FAIRBANKS DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALOHA ORTHODONTICS HERRIMAN

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 W 13400 S STE A
HERRIMAN UT
84096-5636
US

IV. Provider business mailing address

5502 W 13400 S STE A
HERRIMAN UT
84096-5636
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-5729
  • Fax: 801-849-1259
Mailing address:
  • Phone: 801-997-5729
  • Fax: 801-849-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5334209-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: