Edward Robert Fournier Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5373 Issued in CT

Practice address

405 N Main St
Bristol, CT 06010-4924

Phone

(860) 584-0171

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355875200000",
    "number": "1487678231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1738 WOLCOTT RD",
            "city": "WOLCOTT",
            "state": "CT",
            "postal_code": "067161325",
            "telephone_number": "203-879-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 N MAIN ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104924",
            "telephone_number": "860-584-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOURNIER",
        "first_name": "EDWARD",
        "middle_name": "ROBERT",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2012-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "5373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE-DENTAL",
            "identifier": "020005373CT01",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "020005373CT01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary W Florio, LICENSED OPTICIAN
• Gina Catherine Folino
• Blake Forkey, DO
• Angela Fortune, PHARMD
• Jeffrey Scott Fouche-Camargo, DNP, APRN
• Daniel Fox, PHARM D
• Samantha Anne Fraczek
• Ralph J. Frank Jr., R.PH., M.P.H.
• John Arthur Frazier, M.D.
• Laura Michelle Frechette

• General Practice Dentistry in Bristol, CT
• Providers in Bristol, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; 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.