Jon Gordon Fuller Jr., D.D.S.
Individual provider Active NPI General Practice Dentistry · Moab, UT
NPI 1376566976 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376566976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 142288-9921 (UT)
- Practice address
- 570 W 400 N
Moab, UT 84532-2236 - Phone
- (435) 259-4333
- Fax
- (435) 259-6618
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- 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 |
|---|---|---|---|
| 142288-9921 | UT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 142288-9921 | UT | Yes |
Addresses
Primary practice location
570 W 400 N
Moab, UT 84532-2236
Mailing address
570 W 400 N
Moab, UT 84532-2236
Phone (435) 259-4333
Other providers in Moab, UT
- Caroline Floyd
- Amber Dawn Fowler
- Melissa Frandsen
- Kimberly Franke
- Mary Ellen Frothingham
- Lauren Gwen Fuller
- Adriana Gage
- Terry Galen
- Riata L Ganino
- John Garcia
All providers in Moab, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.