Fabian Fuller II, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12053 Issued in TN

Practice address

264 New Shackle Island Rd Ste 105a
Hendersonville, TN 37075-2482

Phone

(615) 477-5011

NPI assigned

Jul 10, 2023

Last updated

Jul 10, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Tooth Extraction Clinic

  • Dental Clinic/Center
  • Hendersonville, TN
  • NPI 1568120160
  NPD

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1467130450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 NEW SHACKLE ISLAND RD STE 105A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752482",
            "telephone_number": "615-477-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 NEW SHACKLE ISLAND RD STE 105A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752482",
            "telephone_number": "615-477-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "FABIAN",
        "name_suffix": "II",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "12053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Frensley
• Ewelina K Freudenberger, MSN, APRN, FNP-BC
• Maegan Freund, PHARMD
• Courtney Friday
• Clayton Matthew Fulks, DMD
• Functional Living Home and Healthcare Services
• Functional Solutions, Inc. (Dynamic Physical & Occupation Therapist)
• Amanda Furgason, RBT
• Bailee Nicole Gad
• Etta Coleen Gaines

• Dentist in Hendersonville, TN
• Providers in Hendersonville, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.