Joseph Fullmer, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7076335-9924 Issued in UT

Practice address

493 S Main St # 200
Heber City, UT 84032-2240

Phone

(435) 315-2050

NPI assigned

Aug 27, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 1, 2018 through Mar 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Heber Valley Oral & Maxillofacial Surgery

  • Dentist
  • Heber City, UT
  • NPI 1043627607
  NPD (past) Authorized official
• Ut Oms Specialty Dental Services PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Heber City, UT
  • NPI 1831956770
  NPD (past)

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589500800000",
    "number": "1487887204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "493 S MAIN ST # 200",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840322240",
            "telephone_number": "435-315-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 S MAIN ST # 200",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840322240",
            "telephone_number": "435-315-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMER",
        "first_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-27",
        "last_updated": "2020-05-15",
        "certification_date": "2020-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "UT",
            "license": "7076335-9924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043627607",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Foster, RN BSN, IBCLC
• Stephen Craig Frogley, D.C.
• Cammi Jo Fruin, AGNP-C
• Kamrie Fryer
• Kiersten Fuller
• Functional Integration Studios LLC
• McKenzie Gardner
• Rebecca Gardner
• Katherine Gillespie
• Tory Justine Goode, OD

• Oral and Maxillofacial Surgery (Dentist) in Heber City, UT
• Providers in Heber City, UT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.