Benjamin Luke Fuller, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

08986 Issued in IA

Practice address

835 3Rd Ave SW
Cedar Rapids, IA 52404-1810

Phone

(319) 366-8377

Fax

(319) 366-7091

NPI assigned

Jun 25, 2009

Last updated

Jul 2, 2013By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 5, 2013 through Aug 5, 2027

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eastern Iowa Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Cedar Rapids, IA
  • NPI 1992962732
  NPD (past)

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372723200000",
    "number": "1689802910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 ROSEBAY CT",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524114701",
            "telephone_number": "319-321-1486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 3RD AVE SW",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524041810",
            "telephone_number": "319-366-8377",
            "fax_number": "319-366-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "BENJAMIN",
        "middle_name": "LUKE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2013-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "6128",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "08986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hallie B Frohn, PHARMD
• Rachel Lea Fry, RN
• Holly Fueston, LMSW
• William E Fulcher, M.D.
• Full Circle Psychology Affiliates, LLC
• Jessica Kay Fuller, D.D.S.
• Fulton Houses, LLC
• Katrina Lynn Fults, LISW
• Functional & Integrative Chiropractic Solutions PLLC
• Michaelangelo Gregory Fuortes, M.D., PH.D.

• Oral and Maxillofacial Surgery (Dentist) in Cedar Rapids, IA
• Providers in Cedar Rapids, IA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.