Connor Fairbanks, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-4836 Issued in ID

Practice address

921 S 8TH Ave Stop 8088
Pocatello, ID 83209-0002

Phone

(208) 282-6000

NPI assigned

Jul 3, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Idaho State University

  • General Practice Dentistry
  • Pocatello, ID
  • NPI 1851516256
  NPD (past)

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499040000000",
    "number": "1952822686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 S 8TH AVE STOP 8088",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832098088",
            "telephone_number": "208-282-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 S 8TH AVE STOP 8088",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090002",
            "telephone_number": "208-282-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "CONNOR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-03",
        "last_updated": "2017-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO STATE BOARD OF DENTISTRY (DENTAL LICENSE)",
            "identifier": "D-4836",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Evans, LSW
• Sunny Evans, LPC
• Facial & Oral Surgery Associates, Inc.
• Robert L Fackrell, DDS
• Jennifer Katherine Fah, PT, DPT
• Robin Pierce Falslev, M.A., CCC-SLP
• Family Focus Mental Health LLC
• Family Pathways Cooperative, Inc.
• Family Practice Group, P.a.
• Family Practice Group, P.a.

• General Practice Dentistry in Pocatello, ID
• Providers in Pocatello, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2017; 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.