Individual provider Active NPI

Kent Jerrold Fyfe, DDS

  • General Practice Dentistry
  • Fontana, CA
National Provider Identifier
1285790261
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
33765 Issued in CA
Practice address
16476 Foothill Blvd
Fontana, CA 92335-3367
Phone
(909) 823-0501
Fax
(909) 823-1472
NPI assigned
Dec 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 33765 CA Primary

Addresses

Primary practice location

16476 Foothill Blvd
Fontana, CA 92335-3367

Mailing address

16476 Foothill Blvd
Fontana, CA 92335-3367
Phone (909) 823-0501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
33765CAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285790261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16476 FOOTHILL BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353367",
            "telephone_number": "909-823-0501",
            "fax_number": "909-823-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16476 FOOTHILL BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353367",
            "telephone_number": "909-823-0501",
            "fax_number": "909-823-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FYFE",
        "first_name": "KENT",
        "middle_name": "JERROLD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "33765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.