IndividualActive
Kelly Fuller, RDH
NPI 1104696152 · Dental Hygienist · Enterprise, OR
Provider details
- NPI number
- 1104696152
- Entity type
- Individual
- Primary specialty
- Dental HygienistDental Providers
- Credential
- RDH
- Sex
- Female
- Sole proprietor
- No
- License
- H8509 (OR)
Specialties & taxonomies
Dental Providers
Practice location
603 Medical Pkwy
Enterprise, OR 97828-5124
Phone: (541) 426-4502
Fax: (541) 426-6403
Approximate (ZIP-level) locationGet directions
Mailing address
603 Medical Pkwy
Enterprise, OR 97828-5124
Registry dates
- Enumerated
- 2024-01-02
- Last updated
- 2024-01-02
- Certified
- 2024-01-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.