Jeremy Lynn Fairbourn, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9270 Issued in KY

Practice address

207A Alpine Dr
Shelbyville, KY 40065-8881

Phone

(502) 633-3900

Fax

(502) 633-3999

NPI assigned

Jul 29, 2010

Last updated

Apr 18, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

• Jeremy L Fairbourn DDS, PLLC

  • General Practice Dentistry
  • Shelbyville, KY
  • NPI 1396081576
  Authorized official Same address or phone

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366243200000",
    "number": "1750695037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207A ALPINE DR",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400658881",
            "telephone_number": "502-633-3900",
            "fax_number": "502-633-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207A ALPINE DR",
            "city": "SHELBYVILLE",
            "state": "KY",
            "postal_code": "400658881",
            "telephone_number": "502-633-3900",
            "fax_number": "502-633-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBOURN",
        "first_name": "JEREMY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-29",
        "last_updated": "2013-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "9270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Jane Eugenio, DMD
• Eumedics Health, LLC
• Samuel L. Evans, MSN, APRN, FNP-C
• Virginia Catherine Evans, APRN, NP-C
• Ronald Everson, M.D.
• Maria Fairbourn, LCSW
• Family Dental Care of Kentucky PSC
• Family Physician Associates PSC
• Finnja Farler, OT
• Amber Lynn Fayne, CNA,CPT

• General Practice Dentistry in Shelbyville, KY
• Providers in Shelbyville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.