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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | Fairbanks, Alfred M DDS | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| ID Number | DE00004076 | [sources] | |||
| NPI | 1851305197 | [sources] | |||
| Status | not available | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers terminated or excluded from Washington State's Medicaid program.
United States of America · HCA
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | Washington State Health Care Authority | - | |||