Spencer Fullmer, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

RES.3003 Issued in OH

Practice address

305 W 12TH Ave
Columbus, OH 43210-1267

Phone

(614) 292-5399

Fax

(614) 688-3608

NPI assigned

Jan 18, 2011

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

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 Jun 17, 2015 through Jun 17, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295308800000",
    "number": "1962707208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 BLUFFTON CT",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432289186",
            "telephone_number": "614-209-8920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W 12TH AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101267",
            "telephone_number": "614-292-5399",
            "fax_number": "614-688-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMER",
        "first_name": "SPENCER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-18",
        "last_updated": "2011-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OH",
            "license": "RES.3003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tawni L. Fuller, C.R.N.A
• Todd Fuller, M.S.N., ACNP-BC
• Victoria Alexander Fullerton, MSW
• Michelle Anne Fullmer
• Rhett Leigh Fullmer, MD
• Fulltimefather LLC
• James P Fulop, MD
• Ember Marie Fulton, OTR/L
• Kim Anise Fulton, LSW
• Kristen Ann Fults-Ganey, MD

• Endodontics in Columbus, OH
• Providers in Columbus, OH by specialty
• Endodontics in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; 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.