Active NPI
Ellis Lamar Fuller, D.D.S
- Dentist
- Lake Mary, FL
National Provider Identifier
1366466286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN15405
- Practice address
- 114 Timberlachen Cir
Lake Mary, FL 32746-3395 - Phone
- (407) 330-3801
- Fax
- (407) 330-5739
- NPI assigned
- Jul 26, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN15405 | FL | Primary |
Addresses
Primary practice location
114 Timberlachen Cir
Lake Mary, FL 32746-3395
Mailing address
1287 Blessing St
Maitland, FL 32751-4260
Phone (407) 838-0101
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 |
|---|---|---|---|
| DN15405 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Mary Dental PA | Past | Accepting new patients | |
| Precision Dental PA | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Lake Mary, FL
- NPI 1639297732
-
- General Practice Dentistry
- Lake Mary, FL
- NPI 1124215892
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340668800000",
"number": "1366466286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1287 BLESSING ST",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327514260",
"telephone_number": "407-838-0101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 TIMBERLACHEN CIR",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327463395",
"telephone_number": "407-330-3801",
"fax_number": "407-330-5739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "ELLIS",
"middle_name": "LAMAR",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2012-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN15405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.