Active NPI
Kevin John Fairclough, DMD
- General Practice Dentistry
- Huntsville, AL
National Provider Identifier
1447408752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3843
- Practice address
- 513 Four Mile Post Rd SE
Huntsville, AL 35802-2345 - Phone
- (256) 503-4693
- NPI assigned
- Aug 29, 2008
- 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 | 3843 | AL | Primary |
Addresses
Primary practice location
513 Four Mile Post Rd SE
Huntsville, AL 35802-2345
Mailing address
513 Four Mile Post Rd SE
Huntsville, AL 35802-2345
Phone (256) 503-4693
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 16, 2015 through Nov 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3843 | AL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429228800000",
"number": "1447408752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "513 FOUR MILE POST RD SE",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358022345",
"telephone_number": "256-503-4693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "513 FOUR MILE POST RD SE",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358022345",
"telephone_number": "256-503-4693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRCLOUGH",
"first_name": "KEVIN",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-29",
"last_updated": "2015-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "3843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntsville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.