Richard J. Fairbrother, DMD, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

003683 Issued in CT

Legal business name

RICHARD J. FAIRBROTHER, DMD, LLC

Practice address

69 South Main St
West Hartford, CT 06107-2410

Phone

(860) 232-2000

Fax

(860) 233-8842

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Virginia C Fairbrother

Title

Practice Manager

Phone

(860) 232-2000

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1376684886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 SOUTH MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072410",
            "telephone_number": "860-232-2000",
            "fax_number": "860-233-8842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 SOUTH MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072410",
            "telephone_number": "860-232-2000",
            "fax_number": "860-233-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD J. FAIRBROTHER, DMD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "FAIRBROTHER",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "860-232-2000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "005785",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "003683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.