Kelly Grace Fuller, RDH
Individual provider Active NPI Dental Hygienist · Enterprise, OR
NPI 1104696152 · NPPES record last updated Jan 2, 2024
Key facts
- NPI
- 1104696152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- H8509 (OR)
- Practice address
- 603 Medical Pkwy
Enterprise, OR 97828-5124 - Phone
- (541) 426-4502
- Fax
- (541) 426-6403
- NPI assigned
- Jan 2, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H8509 | OR | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H8509 | OR | Yes |
Addresses
Primary practice location
603 Medical Pkwy
Enterprise, OR 97828-5124
Mailing address
603 Medical Pkwy
Enterprise, OR 97828-5124
Phone (541) 426-4502
Other providers in Enterprise, OR
- Michael Anthony Farley
- Janet Farrington Graham
- Jason Adam Follett
- Kate Forster
- Frontier Family Medicine PC
- Geunia Funches
- Catherine Kristine Galvan
- Talia Galvin
- Sven Martin Simonne Geirnaert
- Zhenda Glover
All providers in Enterprise, OR · Dental Hygienist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.