Healthcare Provider Details

I. General information

NPI: 1588590913
Provider Name (Legal Business Name): TRIAD SURGICAL ARTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6318 JESSIE LN
CLEMMONS NC
27012-9887
US

IV. Provider business mailing address

5335 ROBINHOOD VILLAGE DR # 178
WINSTON SALEM NC
27106-9820
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-3060
  • Fax: 336-565-2400
Mailing address:
  • Phone: 336-448-3060
  • Fax: 336-565-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOLLY FULLER
Title or Position: PHYSICIAN/OWNER
Credential: MD, PHD
Phone: 336-448-3060