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General NPI Number Information
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NPI Number | 1932353828
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Entity Type | Individual
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Provider Name | JAMIE LEW FAIRCHILD D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 11149 RESEARCH BLVD STE 270
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City | AUSTIN
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State | TX
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Zip | 78759-5227
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Country | US
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Telephone | 512-346-1221
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Fax | 512-502-9689
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Provider Business Mailing Address
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Address Line | 11149 RESEARCH BLVD STE 270
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City | AUSTIN
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State | TX
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Zip | 78759-5227
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Country | US
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Telephone | 512-346-1221
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Fax | 512-502-9689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7085551-9921
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License Number State | UT
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