MEDICARE: DR. DANIEL W FULLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	20686	TX

General Provider Information

NPI Number	:	1174618284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL W FULLER DDS

Provider Business Mailing Address
First Line	:	3323 UNICORN LAKE BLVD # 131
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0102
Country	:	US
Telephone Number	:	940-382-3834
Fax Number	:	940-380-1329

Provider Business Practice Location Address
First Line	:	3323 UNICORN LAKE BLVD # 131
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0102
Country	:	US
Telephone Number	:	940-382-3834
Fax Number	:	940-380-1329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/07/2010

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