NPIMap

Organization Active NPI

Ehlen & Fuller DDS PLLC

Doing business as jack ehlen, dds & julie fuller, dds

  • General Practice Dentistry
  • Puyallup, WA
National Provider Identifier
1316234735
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE60100274 Issued in WA
Legal business name
EHLEN & FULLER DDS PLLC
Doing business as
jack ehlen, dds & julie fuller, dds
Practice address
11208 94TH Ave E
Suite B
Puyallup, WA 98373-3663
Phone
(253) 848-4597
NPI assigned
Jul 6, 2011
Last updated
Jul 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Authorized official

Name
Dr. Julie Fuller, DDSNPI 1447481783
Title
Dentist/Owner
Phone
(253) 848-4597

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00006157 WA
General Practice Dentistry 1223G0001X DE60100274 WA Primary

Addresses

Primary practice location

11208 94TH Ave E
Suite B
Puyallup, WA 98373-3663

Mailing address

11208 94TH Ave E
Suite B
Puyallup, WA 98373-3663
Phone (253) 848-4597

Other names 1

  • jack ehlen, dds & julie fuller, dds Doing business as

National Provider Directory

National Provider Directory

Locations

11208 94th Ave E
Ste B
Puyallup, WA 98373
Phone (253) 848-4597

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1316234735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11208 94TH AVE E",
            "address_2": "SUITE B",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733663",
            "telephone_number": "253-848-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11208 94TH AVE E",
            "address_2": "SUITE B",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733663",
            "telephone_number": "253-848-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EHLEN & FULLER DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-06",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "253-848-4597",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00006157",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60100274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "jack ehlen, dds & julie fuller, dds",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.