Debra S Faires, DDS
Individual provider Active NPI Dentist · Oneida, TN
NPI 1487830857 · NPPES record last updated Jan 16, 2008
Key facts
- NPI
- 1487830857
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS5240 (TN)
- Practice address
- 459 Industrial LN
Oneida, TN 37841-6202 - Phone
- (423) 569-3456
- NPI assigned
- Jan 16, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS5240 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spencer a. Ellis | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS5240 | TN | Yes |
Addresses
Primary practice location
459 Industrial LN
Oneida, TN 37841-6202
Mailing address
281 Woodland PL
Huntsville, TN 37756-3800
Phone (423) 663-8658
Other providers in Oneida, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.