MEDICARE: FULLER & ASSOCIATES V PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1720696560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULLER & ASSOCIATES V PLLC

Provider Business Mailing Address
First Line	:	7722 CHAPEL HILL RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-6256
Country	:	US
Telephone Number	:	919-859-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	7722 CHAPEL HILL RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-6256
Country	:	US
Telephone Number	:	919-859-7006
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. CHAD RUMLEY
Credential	:	SPHR
Telephone Number	:	336-226-0855

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/17/2020

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