Provider Demographics
NPI:1619043940
Name:FULLERTON, WILLIAM LLOYD (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LLOYD
Last Name:FULLERTON
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 1:4680 MONTICELLO AVE STE 16A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8214
Mailing Address - Country:US
Mailing Address - Phone:757-258-1042
Mailing Address - Fax:757-258-1225
Practice Address - Street 1:4680 MONTICELLO AVE STE 16A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8214
Practice Address - Country:US
Practice Address - Phone:757-258-1042
Practice Address - Fax:757-258-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice