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

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Company Details

Legal Name: JONATHAN M. FAIRBANKS, D.D.S., PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: November 28th 2007
Date of Dissolution: April 3rd 2021
Expiration date: 30 Nov 2020
UBI Number: 602 782 191
Home State: UTAH
Principal Office Street Address: Google Maps Logo 1442 S DRAGONFLY DR, LEHI, UT, 84043-5943, UNITED STATES

Contact Details

E-Mail: JEANNEMICHAELLE@GMAIL.COM
Phone Number: +1 509-432-6375

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
BETTE LANG Registered Agent 427 BOYLSON DR., MOSES LAKE, WA, 98837, UNITED STATES

Key Officers & Management

Name Role Address
JEANNE FAIRBANKS Governing Person 1442 S DRAGONFLY DR, LEHI, UT, 84043, UNITED STATES
JONATHAN FAIRBANKS Governing Person 1442 S DRAGONFLY DR, LEHI, UT, 84043, UNITED STATES

National Provider Identifier

NPI Number:
1144546102

Authorized Person:

Name:
DR. JONATHAN MARVIN FAIRBANKS
Role:
DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
5093349239
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