Susan Millie Fagan, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D11945 Issued in OR

Practice address

2650 Washburn Way
Suite 240
Klamath Falls, OR 97603

Phone

(541) 363-0201

NPI assigned

Dec 19, 2006

Last updated

May 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kimball Family Dental

  • General Practice Dentistry
  • Kimball, MI
  • NPI 1407361546
  NPD (past) Authorized official

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1891858742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1932",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "97601",
            "telephone_number": "810-343-1467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 WASHBURN WAY",
            "address_2": "SUITE 240",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "97603",
            "telephone_number": "541-363-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "SUSAN",
        "middle_name": "MILLIE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Nicole Evans, R.D.H.
• Stephani Lyn Evans, MS
• Robyn Ewing, FNP
• Extendicare Homes, Inc. (Klamath Regional Rehabilitation Center)
• Courtney Facey, PTA
• Marrissa Lynn Faill
• Larissa Ann Fain
• Benjamin Holland Fairbanks, MD
• Heather T.S. Fairchild, MSW, CSWA, QMHP
• Jordon Matthew Falconio

• Dentist in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.