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KELLY GRACE FULLER RDH
NPI 1104696152
Dental Hygienist in Enterprise, OR

Active since January 02, 2024
603 MEDICAL PKWY, ENTERPRISE, OR 97828(541) 426-4502(541) 426-6403 Get Directions Write a Review

NPPES record last updated: January 2, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelly Grace Fuller Rdh NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY GRACE FULLER RDH (NPI 1104696152) is an individual dental hygienist in Enterprise, Oregon, licensed in Oregon (H8509) and active in the NPI registry since January 2024.

NPPES Registry Identity

NPI1104696152
Entity TypeIndividualFemale
Primary Taxonomy124Q00000X
Provider Legal NameKELLY GRACE FULLERCredential: RDH
Location Address603 MEDICAL PKWYEnterprise, OR 97828-5124
Mailing Address603 Medical PkwyEnterprise, OR 97828-5124 · (541) 426-4502 · Fax (541) 426-6403
Phone(541) 426-4502
Fax(541) 426-6403
Sole ProprietorNo
Enumeration DateJanuary 2, 2024
NPPES CertifiedJanuary 2, 2024
✔ NPI 1104696152 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDental HygienistDental Providers
Taxonomy Code124Q00000X
License✔ Licensed in OR · H8509
Definition
An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary.
603 MEDICAL PKWY, Enterprise, OR 97828
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RANDI MOVICH RN
Registered Nurse
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (541) 426-4502
WESTON BAKER MD
Family Medicine
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (541) 426-4502
NORA THERESA STANGEL
Registered Nurse
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (541) 426-4502
RONALD DUY LE DMD
Dentist
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (503) 998-6598
WINDING WATERS CLINIC PC
Clinic/Center (Rural Health)
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (541) 426-4502
KRISTEN RUCKDASHEL
Behavior Technician
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (541) 426-4502
JENNIFER LITTLE NP
Nurse Practitioner (Family)
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (541) 426-5460
SUSANNE CRANE PA-C
Physician Assistant (Medical)
603 MEDICAL PKWY
ENTERPRISE, OR 97828
Wallowa County (541) 426-4502

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Fuller's NPI number?

The NPI number for Kelly Fuller is 1104696152. It was assigned to this individual provider in the NPPES registry on January 2, 2024.

Where is Kelly Fuller located?

Kelly Fuller practices at 603 Medical Pkwy, Enterprise, OR 97828. The listed phone number is (541) 426-4502.

What is Kelly Fuller's specialty?

The primary specialty registered for this NPI is Dental Hygienist with taxonomy code 124Q00000X.

When was this NPI record last updated?

The NPPES record for Kelly Fuller was last updated on January 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.