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General NPI Number Information
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NPI Number | 1598011793
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Entity Type | Organization
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Legal Business Name | FULLER AND LEMLEY DENTAL CORP
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 1481 FORD ST SUITE 101
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City | REDLANDS
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State | CA
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Zip | 92373-3916
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Country | US
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Telephone | 909-793-4326
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Fax | 909-793-4339
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Provider Business Mailing Address
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Address Line | 1481 FORD ST SUITE 101
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City | REDLANDS
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State | CA
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Zip | 92373-3916
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Country | US
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Telephone | 909-793-4326
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Fax | 909-793-4339
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAMERON EDWARD FULLER
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Credential | DDS, MS
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Telephone | 909-793-4326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 55344
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License Number State | CA
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