Provider Demographics
NPI:1992536478
Name:FAIRFAX DENTAL OFFICE PLLC
Entity type:Organization
Organization Name:FAIRFAX DENTAL OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:GREY
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-642-3400
Mailing Address - Street 1:158 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:OK
Mailing Address - Zip Code:74637
Mailing Address - Country:US
Mailing Address - Phone:918-642-3400
Mailing Address - Fax:
Practice Address - Street 1:158 N 2ND ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:OK
Practice Address - Zip Code:74637
Practice Address - Country:US
Practice Address - Phone:918-642-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental