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General NPI Number Information
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NPI Number | 1841413473
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Entity Type | Organization
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Legal Business Name | SANDRA L FULLER DDS PA
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1515 WEST CORNWALLIS DR SUITE 120
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City | GREENSBORO
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State | NC
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Zip | 27408
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Country | US
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Telephone | 336-379-1207
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Fax | 336-379-1733
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Provider Business Mailing Address
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Address Line | 1515 WEST CORNWALLIS DR SUITE 120
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City | GREENSBORO
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State | NC
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Zip | 27408
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Country | US
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Telephone | 336-379-1207
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Fax | 336-379-1733
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Authorized Official
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Title or Position | INSURANCE FINANCIAL CORD
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Name | MISS ASHLEY MARIE MCGEE
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Credential |
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Telephone | 336-379-1207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6821
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License Number State | NC
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