Jonathan M. Fairbanks, D.D.S., PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00008587 Issued in WA

Legal business name

JONATHAN M. FAIRBANKS, D.D.S., PLLC

Doing business as

Pullman Smiles

Practice address

1410 SE Bishop Blvd # 1S
Pullman, WA 99163-5419

Phone

(509) 334-6700

Fax

(509) 334-9239

NPI assigned

Apr 15, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jonathan Marvin Fairbanks, DDS

Title

Dentist

Phone

(509) 332-7463

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pullman Smiles Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1144546102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 SE BISHOP BLVD # 1S",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635419",
            "telephone_number": "509-334-6700",
            "fax_number": "509-334-9239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 SE BISHOP BLVD # 1S",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635419",
            "telephone_number": "509-334-6700",
            "fax_number": "509-334-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONATHAN M. FAIRBANKS, D.D.S., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-15",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "FAIRBANKS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "MARVIN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "509-332-7463",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00008587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5033295",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pullman Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Anne Johnson
• Jeanne M Johnson, PH.D., CCC-SLP
• Melissa Lannie Johnson
• Sue Anne Johnson, LMT
• Jonathan B Fisher, DDS,PLLC
• Carla A Jones, M.A., CCC-SLP
• David T Jones, MD
• Janie L Jones, MSPT
• Kathryn Jones
• Keri Lynn Jones, MA, CCC-SLP

• General Practice Dentistry in Pullman, WA
• Providers in Pullman, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.