DR. BRADLEY FULLER (NPI# 1073730784) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073730784 |
| Entity Type | Individual |
| Full Name | DR. BRADLEY FULLER |
| Credential | D.D.S. |
| Practice Address |
2458 Se Burnside Rd Gresham OR 97080-1247 |
| Practice Telephone | 5036668045 |
| Mailing Telephone | 5036668045 |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D7229 | OR | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871015644 | Bradley A Fuller | Physical Therapist | 1401 S Beretania St Ste 550, Honolulu, HI 96814-1880 | 2017-07-12 |
| 1083652564 | Bradley Fuller | Internal Medicine | 2900 12th Ave N, Suite 310w, Billings, MT 59101-7506 | 2006-06-04 |
| Street Address |
2458 SE BURNSIDE RD |
| City | GRESHAM |
| State | OR |
| Zip Code | 97080-1247 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619255809 | Angie Agnes Rawley | Dentist | 2458 Se Burnside Rd, Gresham, OR 97080-1247 | 2011-07-22 |
| 1841529179 | Katherine Mckitrick | Dentist | 2458 Se Burnside Rd, Gresham, OR 97080-1247 | 2009-12-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528428554 | Jeffrey Henry Lucero | Social Worker | 4687 Se 1st Terrace, Gresham, OR 97080 | 2016-03-03 |
| 1124371059 | Nickole Turner | Massage Therapist | 2831 Se Palmquist Rd #157, Gresham, OR 97080 | 2012-10-16 |
| 1992061048 | Russell A Wendt | Pharmacist | 2497 Ne Roberts Ave, Gresham, OR 97080 | 2012-04-03 |
| 1821385584 | Angela West | Counselor | 320 Sw 6th Ave., Gresham, OR 97080 | 2011-07-01 |
| 1043543572 | Natalie Dawn Wilson | Behavioral Analyst | 97 Sw Riverview Place, Gresham, OR 97080 | 2009-09-16 |
| 1427205442 | Maria G Jolley | Dental Hygienist | 1267 Se Stapleton Loop, Gresham, OR 97080 | 2008-08-21 |
| 1073776738 | Sabrina Joye Hindman | Marriage & Family Therapist | 6370 Se 26th St, Gresham, OR 97080 | 2008-07-03 |
| 1669676193 | Kimberly Sabin | Nurse Practitioner | 2222 E Powell Blvd, Gresham, OR 97080 | 2007-06-11 |
| 1932223880 | Julie Elizabeth Croshaw | Pharmacist | 2444 E Powell Blvd, Gresham, OR 97080 | 2007-03-18 |
| 1508903261 | Lonetta Elise Davis | Adult Companion | 349 Se Plamblad, Gresham, OR 97080 | 2007-01-31 |
| Find all providers in zip 97080 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083062020 | Nhu Nguyen | Dentist | 315 Nw Burnside Rd, Gresham, OR 97030-3851 | 2016-06-01 |
| 1013321587 | Matthew Vogel | Dentist | 1201 Se 223rd Ave Ste 140, Gresham, OR 97030 | 2014-06-12 |
| 1164680047 | Kurt David Fuerstenau | Dentist | 1605 Sw Walters Dr, Gresham, OR 97080-9355 | 2008-05-28 |
| 1750587085 | Gary Stewart Cooke | Dentist | 490 E Powell Blvd, Gresham, OR 97030-7610 | 2007-06-24 |
| 1578689659 | Paynter Family Dentistry, PC | Dentist | 445 W Powell Blvd, Gresham, OR 97030-7048 | 2007-03-21 |
| 1285795690 | Vicki J Reichlein | Dentist | 2039 Ne Burnside Rd, Gresham, OR 97030-7998 | 2006-12-12 |
| 1982772026 | Cristina Pellicano Kennedy | Dentist | 501 Ne Hood Ave Ste 235, Gresham, OR 97030-7346 | 2006-11-30 |
| 1720159221 | Raymond Shigeuki Onchi | Dentist | 35 Ne Kelly Ave, Gresham, OR 97030-7539 | 2006-11-13 |
| 1598854929 | Dmitri Vladislavovich Aleksandrov | Dentist | 600 Ne 8th St Ste 210, Gresham, OR 97030-7341 | 2006-10-12 |
| 1205922267 | Steven Salisbury | Dentist | 1446 E Powell Blvd, Gresham, OR 97030-8038 | 2006-10-05 |
| Find all providers in GRESHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.