MEDICARE: JULIAN H. FAIR 3RD,DMD,PA

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	122300000X	Dentist

General Provider Information

NPI Number	:	1679787626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIAN H. FAIR 3RD,DMD,PA

Provider Business Mailing Address
First Line	:	PO BOX 800
Second Line	:
City	:	WAGENER
State	:	SC
Zip	:	29164-0800
Country	:	US
Telephone Number	:	803-564-3446
Fax Number	:	803-564-5254

Provider Business Practice Location Address
First Line	:	112 LOUIE ST.
Second Line	:
City	:	WAGENER
State	:	SC
Zip	:	29164-0800
Country	:	US
Telephone Number	:	803-564-3446
Fax Number	:	803-564-5254

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIAN H FAIR 3RD
Credential	:	DMD
Telephone Number	:	803-564-3446

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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