NPIMap

Organization Active NPI

Heber Valley Oral & Maxillofacial Surgery

  • Dentist
  • Heber City, UT
National Provider Identifier
1043627607
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
HEBER VALLEY ORAL & MAXILLOFACIAL SURGERY
Practice address
493 S Main St
Suite 200
Heber City, UT 84032-2240
Phone
(435) 315-2050
Fax
(435) 503-9526
NPI assigned
Jul 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Authorized official

Name
Dr. Joseph Fullmer, DMDNPI 1487887204
Title
Owner
Phone
(435) 315-2050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

493 S Main St
Suite 200
Heber City, UT 84032-2240

Mailing address

493 S Main St
Suite 200
Heber City, UT 84032-2240
Phone (435) 315-2050

National Provider Directory

National Provider Directory

Locations

493 S Main St
Ste 200
Heber City, UT 84032
Phone (435) 315-2050

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1043627607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "493 S MAIN ST",
            "address_2": "SUITE 200",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840322240",
            "telephone_number": "435-315-2050",
            "fax_number": "435-503-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 S MAIN ST",
            "address_2": "SUITE 200",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840322240",
            "telephone_number": "435-315-2050",
            "fax_number": "435-503-9526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEBER VALLEY ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "FULLMER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-315-2050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Heber City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; 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.