Provider Demographics
NPI:1598011793
Name:FULLER AND LEMLEY DENTAL CORP
Entity Type:Organization
Organization Name:FULLER AND LEMLEY DENTAL CORP
Other - Org Name:PEDIATRIC DENTISTRY OF REDLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:909-793-4326
Mailing Address - Street 1:1481 FORD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3916
Mailing Address - Country:US
Mailing Address - Phone:909-793-4326
Mailing Address - Fax:909-793-4339
Practice Address - Street 1:1481 FORD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3916
Practice Address - Country:US
Practice Address - Phone:909-793-4326
Practice Address - Fax:909-793-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty