DR. BENJAMIN LUKE FULLER (NPI# 1689802910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689802910 |
| Entity Type | Individual |
| Full Name | DR. BENJAMIN LUKE FULLER |
| Credential | D.D.S. |
| Practice Address |
835 3rd Ave Sw Cedar Rapids IA 52404-1810 |
| Mailing Address |
2825 Rosebay Ct Cedar Rapids IA 52411-4701 |
| Practice Telephone | 3193668377 |
| Practice Fax Number | 3193667091 |
| Mailing Telephone | 3193211486 |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2013-07-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
08986 | IA | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
6128 | OK | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407400799 | Benjamin Fuller | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2019-07-25 |
| 1841710902 | Benjamin Fuller | Anesthesiology | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2017-06-20 |
| Street Address |
835 3RD AVE SW |
| City | CEDAR RAPIDS |
| State | IA |
| Zip Code | 52404-1810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285233064 | Physiotherapy Associates, Inc. | Clinic/Center | 998 Westdale Parkway, Cedar Rapids, IA 52404 | 2020-10-22 |
| 1528617313 | Humble Language Institute | Interpreter | 3513 Royal Dr. Sw, Cedar Rapids, IA 52404 | 2019-09-05 |
| 1073169074 | Jackie Lugene Mcfetridge | Technician | 3528 Falcon View Rd Sw, Cedar Rapids, IA 52404 | 2019-08-15 |
| 1003460312 | Rem Iowa, Inc. | Intermediate Care Facility, Mentally Retarded | 143 16th Ave Sw, Cedar Rapids, IA 52404 | 2019-07-25 |
| 1811541121 | Rem Iowa, Inc. | Intermediate Care Facility, Mentally Retarded | 2620 33rd Ave Sw, Cedar Rapids, IA 52404 | 2019-07-25 |
| 1659859569 | Wanda Marie Mokry-sellers | Counselor | 3601 16th Avenue Sw, Cedar Rapids, IA 52404 | 2018-08-02 |
| 1790231371 | Freddie Lederle | Taxi | 3260 Southgate Place, Cedar Rapids, IA 52404 | 2016-09-01 |
| 1619422748 | Mercy Physician Associates, Inc | Family Medicine | 777 76th Ave Dr Sw, Cedar Rapids, IA 52404 | 2016-08-18 |
| 1740638626 | Lasharon Leah Taylor | Counselor | 3330 Southgate Ct Sw, Cedar Rapids, IA 52404 | 2016-06-01 |
| 1689094112 | Pathway Counseling Center | Clinic/Center | 1073 Rockford Rd Se, Suite E, Cedar Rapids, IA 52404 | 2014-04-23 |
| Find all providers in zip 52404 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518943174 | Daniel S Sarasin | Dentist | 835 3rd Ave Se, Cedar Rapids, IA 52403-2407 | 2005-12-15 |
| 1841458981 | Cedar Rapids Oral Surgery, PC | Dentist | 835 3rd Ave Se, Cedar Rapids, IA 52403-2407 | 2008-05-27 |
| 1992962732 | Eastern Iowa Oral and Maxillofacial Surgery | Dentist | 835 3rd Ave Se, Cedar Rapids, IA 52403-2407 | 2008-05-20 |
| 1083644454 | Larry A Mccray | Dentist | 835 3rd Ave Se, Cedar Rapids, IA 52403-2407 | 2006-07-03 |
| 1891771960 | John R Van Heukelom | Dentist | 835 3rd Ave Se, Cedar Rapids, IA 52403-2407 | 2005-12-20 |
| 1821074477 | Kurt Jeffrey Westlund | Dentist | 835 3rd Ave Se, Cedar Rapids, IA 52403-2407 | 2005-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154970655 | Advanced Oral Surgery, Pllc | Dentist | 3265 S 24th St, Council Bluffs, IA 51501-6901 | 2019-09-06 |
| 1528421237 | Timothy Scott Albright | Dentist | 2814 Northgate Dr Ste 2, Iowa City, IA 52245-9513 | 2016-03-30 |
| 1467846519 | Edward H Schaefer Iv | Dentist | 201 Ridge St Ste 308, Council Bluffs, IA 51503-4643 | 2015-03-26 |
| 1386087658 | Michael Morio | Dentist | 7400 Fleur Dr Ste 200, Des Moines, IA 50321-3105 | 2013-04-16 |
| 1245550003 | Douglas Kendrick | Dentist | 451 Dental Science Bldg S, Iowa City, IA 52242-1001 | 2010-06-03 |
| 1013234194 | Ryan Norman Borgwardt | Dentist | 820 Fisher Drive, Waterloo, IA 50701 | 2010-04-28 |
| 1801093067 | Ryan A Marsh | Dentist | 7400 Fleur Dr, Ste 200, Des Moines, IA 50321-3105 | 2007-06-29 |
| 1386847630 | John D. Janulewicz | Dentist | 7400 Fleur Drive, Suite 200, Des Moines, IA 50321-3104 | 2007-06-06 |
| 1396952297 | Jonathan R Dejong | Dentist | 804 Kenyon Rd Ste 120, Fort Dodge, IA 50501-5746 | 2007-05-17 |
| 1013038447 | Morgan and Morio Oral and Maxillofacial Surgery | Dentist | 1395 Boyson Rd, Hiawatha, IA 52233-2210 | 2007-04-03 |
| Find all providers with the same taxonomy | ||||
| City | CEDAR RAPIDS |
| Zip Code | 52404 |
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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.