Provider Demographics
NPI:1770042368
Name:FULLER & ASSOCIATES II, P.A.
Entity Type:Organization
Organization Name:FULLER & ASSOCIATES II, P.A.
Other - Org Name:MCLEANSVILLE FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:STRAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-343-4532
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:336-343-4532
Mailing Address - Fax:
Practice Address - Street 1:5706 MCLEANSVILLE RD
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9303
Practice Address - Country:US
Practice Address - Phone:336-697-0618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty