Individual provider Active NPI

Casey Glenn Fishburn, D.M.D.

  • General Practice Dentistry
  • Muskogee, OK
National Provider Identifier
1730181579
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4411 Issued in KS
Practice address
2205 Chandler Rd
Muskogee, OK 74403-4626
Phone
(918) 683-2291
Fax
(918) 683-2491
NPI assigned
Aug 11, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4411 KS Primary

Addresses

Primary practice location

2205 Chandler Rd
Muskogee, OK 74403-4626

Mailing address

2601 Haddock Dr
Muskogee, OK 74401-2903
Phone (918) 682-5158

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160212000715 OK Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7517124126

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4411KSMDClinical Social Worker
4411OKMDSpeech/Language/Hearing Specialist/Technologist

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730181579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 HADDOCK DR",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744012903",
            "telephone_number": "918-682-5158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 CHANDLER RD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744034626",
            "telephone_number": "918-683-2291",
            "fax_number": "918-683-2491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHBURN",
        "first_name": "CASEY",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "4411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskogee, OK

Sources for this page

Verify at the official NPI Registry.