Individual provider Active NPI

Fiona M Nunes

  • General Practice Dentistry
  • Georgetown, TX
National Provider Identifier
1457555492
Registry record updated Jul 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
23086 Issued in TX
Practice address
2411 Williams Dr
Suite 111
Georgetown, TX 78628-3261
Phone
(512) 864-1445
Fax
(512) 864-1447
NPI assigned
Jun 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2008

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 23086 TX Primary

Addresses

Primary practice location

2411 Williams Dr
Suite 111
Georgetown, TX 78628-3261

Mailing address

1500 W University Ave
Suite 103
Georgetown, TX 78628-7108
Phone (512) 868-1124

Other identifiers 1

IdentifierTypeStateIssuer
191198401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20160107002971 TX Order and Referring Only - DentistPractitioner - Dentist 8921187360

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216684800000",
    "number": "1457555492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 W UNIVERSITY AVE",
            "address_2": "SUITE 103",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786287108",
            "telephone_number": "512-868-1124",
            "fax_number": "512-868-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 WILLIAMS DR",
            "address_2": "SUITE 111",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283261",
            "telephone_number": "512-864-1445",
            "fax_number": "512-864-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNES",
        "first_name": "FIONA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2008-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "23086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191198401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.