Provider Demographics
NPI:1396383451
Name:FULLER & ASSOCIATES III, PA
Entity Type:Organization
Organization Name:FULLER & ASSOCIATES III, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-343-4543
Mailing Address - Street 1:3450 FORESTDALE DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9142
Mailing Address - Country:US
Mailing Address - Phone:336-226-0855
Mailing Address - Fax:
Practice Address - Street 1:210 NEW FIDELITY CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2896
Practice Address - Country:US
Practice Address - Phone:919-329-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty