Individual provider Active NPI

Fannie Baillargeon, DMD

  • Dentist
  • Ventura, CA
National Provider Identifier
1710339684
Registry record updated Jul 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
101673 Issued in CA
Practice address
200 S Wells Rd Ste 225
Ventura, CA 93004-1382
Phone
(805) 659-0560
Fax
(805) 647-7164
NPI assigned
Jul 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 101673 CA Primary

Addresses

Primary practice location

200 S Wells Rd Ste 225
Ventura, CA 93004-1382

Mailing address

1040 Flynn Rd
Camarillo, CA 93012-5092
Phone (805) 673-3930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170817002213 CA Order and Referring Only - Other (Non-Physician) 1951673425

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
101673CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Clinicas del Camino Real Inc Past Accepting new patients
Clinicas del Camino Real Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: fannie.baillargeon.p1@direct.aihs.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501113600000",
    "number": "1710339684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125092",
            "telephone_number": "805-673-3930",
            "fax_number": "805-659-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S WELLS RD STE 225",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041382",
            "telephone_number": "805-659-0560",
            "fax_number": "805-647-7164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILLARGEON",
        "first_name": "FANNIE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-05",
        "last_updated": "2017-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.