Craig H Fountain, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901018208 Issued in MI

Practice address

12776 S West Bay Shore Dr
Traverse City, MI 49684-5451

Phone

(231) 946-3512

Fax

(231) 946-1908

NPI assigned

May 19, 2006

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 3

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

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198713600000",
    "number": "1992759625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 CASS ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843234",
            "telephone_number": "231-392-5810",
            "fax_number": "231-946-1908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12776 S WEST BAY SHORE DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845451",
            "telephone_number": "231-946-3512",
            "fax_number": "231-946-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "CRAIG",
        "middle_name": "H",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901018208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4756423",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP #",
            "identifier": "1003095605",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4756432",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter Russell Foster-Fishman, PSY.D.
• Mary Katherine Foster
• Maryann Fouch
• Renee Fouch
• Allison Noel Fought
• Kayla Rose Fournier
• Melissa Fournier, LMSW
• Neesha Elizabeth Fournier, MD
• Rachel Fournier, LPC
• William C Fowle, LMSW

• Oral and Maxillofacial Surgery (Dentist) in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; 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.