Imani Joy Fuller

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

17689 Issued in MD

Practice address

1107 Sligo Creek Pkwy
Takoma Park, MD 20912-5806

Phone

(301) 891-7760

NPI assigned

Sep 27, 2021

Sex

Female

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

Interoperability endpoints

• Direct secure messaging: ifuller236575@direct.bmc.masshiway.net

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.

• Dr. Camps Pediatric Dental Center

  • Pediatric Dentistry
  • Silver Spring, MD
  • NPI 1265423842
  NPD
• Boston Medical Center Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1346218294
  NPD
• Gregory O. Catchings DMD PA

  • Preferred Provider Organization
  • Takoma Park, MD
  • NPI 1396285672
  NPD (past)

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

{
    "created_epoch": "1632700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1801567144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19318 TATTERSHALL DR",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208746245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 SLIGO CREEK PKWY",
            "city": "TAKOMA PARK",
            "state": "MD",
            "postal_code": "209125806",
            "telephone_number": "301-891-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "IMANI",
        "middle_name": "JOY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-27",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "17689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Frankel, LICSW
• Tonya Denise Frazier, M.A.
• Gladys Nchang Fru
• Patricia Frye, MD
• Erin E Fulham, CNM
• Jamie Futterman, RD
• Wosene Tikuye G Eyessus
• Kathleen Garber, LCSW-C
• John F Garcia, MD
• Denetra Gary, LCSW, LCSW-C

• Pediatric Dentistry in Takoma Park, MD
• Providers in Takoma Park, MD by specialty
• Pediatric Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; 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.