Provider Demographics
NPI:1285981555
Name:FAIRCHILD, JUDE PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JUDE
Middle Name:PAUL
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1837 W PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1223
Mailing Address - Country:US
Mailing Address - Phone:337-478-2805
Mailing Address - Fax:337-478-1837
Practice Address - Street 1:1837 W PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1223
Practice Address - Country:US
Practice Address - Phone:337-478-2805
Practice Address - Fax:337-478-1837
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA59901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics