Jacob Fillebrown, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN4562 Issued in ME

Practice address

324 Gannett Dr Ste 500
South Portland, ME 04106-3361

Phone

(207) 253-5600

NPI assigned

Jun 23, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gannett Drive Dental PLLC

  • Dental Clinic/Center
  • South Portland, ME
  • NPI 1710755590
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498176000000",
    "number": "1003336702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 GANNETT DR STE 500",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041063361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 GANNETT DR STE 500",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041063361",
            "telephone_number": "207-253-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILLEBROWN",
        "first_name": "JACOB",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-23",
        "last_updated": "2017-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DEN4562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Paul Felton, PHARMD
• Julia Fenton Schnee, LCSW
• Emeline Speyer Ferguson, LCSW
• Stephen Ferguson
• Sarah S Ferriss, LCSW
• Kiley Fine, LCPC
• June Caroline Finnemore, LCSW
• David G Fitz, MD
• Deklin T Fitzgerald
• Rosemary Eileen Fitzpatrick, P.A.

• General Practice Dentistry in South Portland, ME
• Providers in South Portland, ME by specialty
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.