Active NPI
Michael J Fanning, D.D.S., M.S.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Albuquerque, NM
National Provider Identifier
1700153475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DD3356
- Practice address
- 8212 Louisiana Blvd NE Ste a
Albuquerque, NM 87113-2105 - Phone
- (505) 400-9855
- NPI assigned
- Nov 24, 2011
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DD3356 | NM | Primary |
Addresses
Primary practice location
8212 Louisiana Blvd NE Ste a
Albuquerque, NM 87113-2105
Mailing address
5507 Eakes Rd NW
Los Ranchos, NM 87107-5529
Phone (505) 400-9855
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3356 | NM | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322092800000",
"number": "1700153475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5507 EAKES RD NW",
"city": "LOS RANCHOS",
"state": "NM",
"postal_code": "871075529",
"telephone_number": "505-400-9855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8212 LOUISIANA BLVD NE STE A",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871132105",
"telephone_number": "505-400-9855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANNING",
"first_name": "MICHAEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-24",
"last_updated": "2011-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NM",
"license": "DD3356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.