Kevin Jon Fairhurst, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D-4144 Issued in ID

Practice address

900 10TH Ave NW
Great Falls, MT 59404-1747

Phone

(406) 761-1365

Fax

(406) 403-0418

NPI assigned

Jun 23, 2008

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1093976904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 10TH AVE NW",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594041747",
            "telephone_number": "406-761-1365",
            "fax_number": "406-403-0418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 10TH AVE NW",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594041747",
            "telephone_number": "406-761-1365",
            "fax_number": "406-403-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRHURST",
        "first_name": "KEVIN",
        "middle_name": "JON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-23",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANA LICENCE NUMBER",
            "identifier": "2397",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Falls Neuropsychological Services, P.C.
• Family Birth Center, LLC
• Family Eye Care, LLC

• Dentist in Great Falls, MT
• Providers in Great Falls, MT by specialty
• Dentist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.