Dr James Leo Fairbanks, DMD is a
Dentist based in Licking, Missouri. Dr James Leo Fairbanks is licensed to practice in Missouri (license number 2021026049) and his current practice location is
255 W Highway 32, Licking, Missouri. He can be reached at his office (for appointments etc.) via phone at
(573) 674-4470.
NPI number for Dr James Leo Fairbanks is 1356629059 and his current mailing address is 255 W Highway 32, Licking, Missouri. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1356629059.
Healthcare Provider's Profile
| Full Name | Dr James Leo Fairbanks |
|---|
| Gender | Male |
|---|
| Speciality | Dentist |
|---|
| Location | 255 W Highway 32, Licking, Missouri |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1356629059
- Provider Enumeration Date: 07/28/2011
- Last Update Date: 12/08/2023
Medical Identifiers
Medical identifiers for Dr James Leo Fairbanks such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1356629059 | NPI | - | NPPES |
| 103036832 0001 | Medicaid | PA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | 8385285-9922 (Utah) | Secondary |
| 1223G0001X | Dentist - General Practice | 61351 (Kansas) | Secondary |
| 1223G0001X | Dentist - General Practice | DS040267 (Pennsylvania) | Secondary |
| 122300000X | Dentist | 2021026049 (Missouri) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr James Leo Fairbanks is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr James Leo Fairbanks, DMD
255 W Highway 32,
Licking, MO 65542-9069
Ph: () - | Dr James Leo Fairbanks, DMD
255 W Highway 32,
Licking, MO 65542-9076
Ph: (573) 674-4470 |
Reviews and Comments