Provider Demographics
NPI:1194840934
Name:FULLER, ROSS S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:S
Last Name:FULLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3365
Mailing Address - Country:US
Mailing Address - Phone:757-229-7210
Mailing Address - Fax:757-220-4764
Practice Address - Street 1:1319 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3365
Practice Address - Country:US
Practice Address - Phone:757-229-7210
Practice Address - Fax:757-220-4764
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice