Jeffrey Fenn, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

30876 Issued in TX

Practice address

1923 Marsha Sharp Fwy
Lubbock, TX 79415-4036

Phone

(806) 589-0081

NPI assigned

May 23, 2014

Last updated

Apr 18, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Practice roles

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

• Dr Wisdom Teeth

  • Dental Clinic/Center
  • San Tan Valley, AZ
  • NPI 1992298533
  NPD Authorized official
• East 22ND Street Dental, P.C.

  dba Dorsett Dentistry

  • General Practice Dentistry
  • Tucson, AZ
  • NPI 1396832994
  NPD (past)

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

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460937600000",
    "number": "1427460575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 MARSHA SHARP FWY",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794154036",
            "telephone_number": "806-589-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 MARSHA SHARP FWY",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794154036",
            "telephone_number": "806-589-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENN",
        "first_name": "JEFFREY",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-23",
        "last_updated": "2016-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30876",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "9669",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D009399",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol KK Felton, M.D.
• Jason Andrew Felton, M.D.
• Shaili Khandheria Felton, MD
• Cassy L Felts, M.D.
• Kathleen Brinkman Felts, P.T.
• Kari Amanda Fennell, FNP-C
• June M Fennerty, OTR, CHT
• Boyd S Fenton, M.D.
• Helen Feola, LPC
• MST Jannatul Ferdous, MD

• Dentist in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; 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.