Provider Demographics
NPI:1891018040
Name:FULLER, VALERIE CLAUDIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:CLAUDIA
Last Name:FULLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:CLAUDIA
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:317 N ZANE HWY
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1624
Mailing Address - Country:US
Mailing Address - Phone:740-633-1800
Mailing Address - Fax:
Practice Address - Street 1:317 N ZANE HWY
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935
Practice Address - Country:US
Practice Address - Phone:740-633-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA388037957CMedicaid