MEDICARE: FULLER & ASSOCIATES II, P.A.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1770042368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULLER & ASSOCIATES II, P.A.

Provider Business Mailing Address
First Line	:	3450 FORESTDALE DR
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-9142
Country	:	US
Telephone Number	:	336-343-4532
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 MCLEANSVILLE RD
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9303
Country	:	US
Telephone Number	:	336-697-0618
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. ANNETTE F STRAUGHAN
Credential	:
Telephone Number	:	336-343-4532

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	12/19/2019

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