Provider Demographics
NPI:1932353828
Name:FAIRCHILD, JAMIE LEW (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LEW
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11149 RESEARCH BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5227
Mailing Address - Country:US
Mailing Address - Phone:512-346-1221
Mailing Address - Fax:512-502-9689
Practice Address - Street 1:11149 RESEARCH BLVD STE 270
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5227
Practice Address - Country:US
Practice Address - Phone:512-346-1221
Practice Address - Fax:512-502-9689
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7085551-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist