Active NPI
William Charles Fincannon, D.D.S.
- General Practice Dentistry
- Jasper, TX
National Provider Identifier
1427278175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12434
- Practice address
- 1001 W Gibson St
Jasper, TX 75951-4803 - Phone
- (409) 384-7997
- Fax
- (409) 384-2864
- NPI assigned
- Apr 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12434 | TX | Primary |
Addresses
Primary practice location
1001 W Gibson St
Jasper, TX 75951-4803
Mailing address
1001 W Gibson St
Jasper, TX 75951-4803
Phone (409) 384-7997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Sep 19, 2016 through Sep 19, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12434 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427278175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 W GIBSON ST",
"city": "JASPER",
"state": "TX",
"postal_code": "759514803",
"telephone_number": "409-384-7997",
"fax_number": "409-384-2864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W GIBSON ST",
"city": "JASPER",
"state": "TX",
"postal_code": "759514803",
"telephone_number": "409-384-7997",
"fax_number": "409-384-2864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FINCANNON",
"first_name": "WILLIAM",
"middle_name": "CHARLES",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "12434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jasper, TX
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.