Michael Jordan Fetner, D.M.D., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN19049 Issued in FL

Practice address

7043 Southpoint Pkwy S Ste B
Jacksonville, FL 32216-8742

Phone

(904) 296-8343

NPI assigned

Nov 30, 2010

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

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.

Opted out of Medicare

Yes, effective Mar 11, 2014 through Mar 11, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Fetner and Hartigan, Periodontics

  • Periodontics
  • Jacksonville, FL
  • NPI 1053642264
  NPD (past)

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1871895680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7043 SOUTHPOINT PKWY S STE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168742",
            "telephone_number": "904-296-8343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7043 SOUTHPOINT PKWY S STE B",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168742",
            "telephone_number": "904-296-8343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETNER",
        "first_name": "MICHAEL",
        "middle_name": "JORDAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-30",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN19049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fetner and Hartigan, Periodontics
• Alan E Fetner, DMD
• Alexander J Fetner, D.M.D.
• Dina Levin Fetner, D.D.S.
• Howard A Fetner, DMD
• Heather Marie Fewox-Steen, M.S.
• Anteneh M Feyissa, MD
• FG Family Health Corp
• Leslie Ann Fiala, R.D.
• Michael J Fialho, MD

• Periodontics in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.