Active NPI
Michael Dennis Fahey, DDS
- General Practice Dentistry
- Winnie, TX
National Provider Identifier
1619076783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11246
- Practice address
- 502 3Rd Street
Winnie, TX 77665 - Phone
- (409) 296-4149
- Fax
- (409) 296-4711
- NPI assigned
- Sep 22, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 11246 | TX | Primary |
Addresses
Primary practice location
502 3Rd Street
Winnie, TX 77665
Mailing address
PO Box 747
Winnie, TX 77665
Phone (409) 296-4149
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160308000140 | TX | Order and Referring Only - Dentist | 0648576306 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11246 | TX | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619076783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 747",
"city": "WINNIE",
"state": "TX",
"postal_code": "77665",
"telephone_number": "409-296-4149",
"fax_number": "409-296-4711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 3RD STREET",
"city": "WINNIE",
"state": "TX",
"postal_code": "77665",
"telephone_number": "409-296-4149",
"fax_number": "409-296-4711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAHEY",
"first_name": "MICHAEL",
"middle_name": "DENNIS",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "11246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winnie, TX
- Coastal Gateway Health Center
- Martha Davis, P.A.
- Daniel Sean Degarmo, RN, ENP
- East Chambers Isd
- Vannessa Veronique Evans, NP
- Kacey White Flores, PA-C
- Ayesha Hafsa Hasan, M.D
- Sara E Hollier, FNP-C
- Integrative Healers Collective & Texas Nursing PLLC (The Integrative Healers Collective)
- Felix C Jackson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.