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General NPI Number Information
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NPI Number | 1588590913
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Entity Type | Organization
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Legal Business Name | TRIAD SURGICAL ARTS PLLC
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 6318 JESSIE LN
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City | CLEMMONS
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State | NC
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Zip | 27012-9887
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Country | US
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Telephone | 336-448-3060
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Fax | 336-565-2400
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Provider Business Mailing Address
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Address Line | 5335 ROBINHOOD VILLAGE DR # 178
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City | WINSTON SALEM
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State | NC
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Zip | 27106-9820
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Country | US
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Telephone | 336-448-3060
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Fax | 336-565-2400
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MOLLY FULLER
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Credential | MD, PHD
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Telephone | 216-272-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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