Individual
KELLY GRACE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
603 MEDICAL PKWY, ENTERPRISE, OR 97828-5124
(541) 426-4502
(541) 426-6403
Mailing address
603 MEDICAL PKWY, ENTERPRISE, OR 97828-5124
(541) 426-4502
(541) 426-6403
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H8509
OR
Other
Enumeration date
01/02/2024
Last updated
01/02/2024
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