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General NPI Number Information
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NPI Number | 1609949155
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Entity Type | Organization
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Legal Business Name | RAWLEY H. FULLER, IV, DDS, PA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 3450 FORESTDALE DR.
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City | BURLINGTON
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State | NC
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Zip | 27215-9142
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Country | US
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Telephone | 336-226-0855
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Fax | 336-226-0137
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Provider Business Mailing Address
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Address Line | 3450 FORESTDALE DR.
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City | BURLINGTON
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State | NC
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Zip | 27215-9142
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Country | US
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Telephone | 336-226-0855
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Fax | 336-226-0137
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Authorized Official
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Title or Position | DENTIST & OWNER
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Name | DR. RAWLEY HARRISON FULLER IV
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Credential | DDS, PA
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Telephone | 336-226-0855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6491
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License Number State | NC
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