Kelly Grace Fuller, RDH
Dental Hygienist in Enterprise, OR. Individual provider (NPI-1).
NPI number1104696152
StatusActive
Last updated in NPPESJan 2, 2024
Details
- NPI
- 1104696152
- Entity type
- Individual (NPI-1)
- Name
- Kelly Grace Fuller
- Credential
- RDH
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 2, 2024
- Certification date
- Jan 2, 2024
- Last updated
- Jan 2, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 124Q00000X | Dental Hygienist | H8509 | OR | Yes |
Practice location
603 Medical PkwyEnterprise, OR 97828-5124
Phone 541-426-4502 · Fax 541-426-6403
Mailing address
603 Medical PkwyEnterprise, OR 97828-5124
Phone 541-426-4502 · Fax 541-426-6403
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