Active NPI
David Allen Fuller, D.M.D.
- General Practice Dentistry
- Bend, OR
National Provider Identifier
1275590101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5954
- Practice address
- 2250 NE Professional CT.
Bend, OR 97701-6063 - Phone
- (541) 388-1434
- Fax
- (541) 388-1293
- NPI assigned
- Apr 26, 2006
- Last updated
- Feb 27, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5954 | OR | Primary |
Addresses
Primary practice location
2250 NE Professional CT.
Bend, OR 97701-6063
Mailing address
2250 NE Professional CT.
Bend, OR 97701-6063
Phone (541) 388-1434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5954 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Taylor C. Fowles, DMD, LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393459200000",
"number": "1275590101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2250 NE PROFESSIONAL CT.",
"city": "BEND",
"state": "OR",
"postal_code": "977016063",
"telephone_number": "541-388-1434",
"fax_number": "541-388-1293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 NE PROFESSIONAL CT.",
"city": "BEND",
"state": "OR",
"postal_code": "977016063",
"telephone_number": "541-388-1434",
"fax_number": "541-388-1293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "DAVID",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2014-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "5954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.