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Deactivated NPI 1235271248 Deactivated / Inactive NPI Male Practitioner

Dr. Kenneth Joy Fuller Jr , DMD

Dentist • Tempe, AZ

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kenneth Fuller Jr has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 13, 2007
NPI Deactivation Date September 15, 2017
Total Practice Duration ~10 Years of Practice (2007 – 2017)

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Fuller Jr, DMD was a registered Dentist practicing in Tempe, AZ. Throughout an active medical career spanning 10 years, Dr. Fuller Jr provided care at the practice location at 161 E BROADWAY RD until profile deactivation on 2017-09-15.

Practice Location & Contact Primary Location

Practice Address

161 E Broadway Rd

Tempe, AZ 852821304

Telephone 4809681534

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Tempe, AZ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 47.0 Yrs
State Avg: 12.3 Yrs
Regional Practice Density
51 Specialists

Practicing in Tempe, AZ (1999 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License AZ 2277

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated September 15, 2017

Record deactivated on September 15, 2017

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 161 E BROADWAY RD, TEMPE, AZ 852821304 (Tel: 4809681534)

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Updated Business Mailing Address July 08, 2007

Registered at 161 E BROADWAY RD, TEMPE, AZ 852821304

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Provider Name / Credentials Updated July 08, 2007

Recorded as KENNETH FULLER JR, DMD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #2277 in AZ)

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Initial NPI Registration & Enumeration February 13, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1235271248
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 13, 2007
Last Update: July 08, 2007
Deactivation Date: September 15, 2017

Mailing Address

161 E Broadway Rd

Tempe, AZ 852821304

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.