Provider Demographics
NPI:1720283757
Name:REYNA FULLER, MARIA DEL ROSARIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DEL ROSARIO
Last Name:REYNA FULLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 QUARRY ROAD
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:IA
Mailing Address - Zip Code:50841
Mailing Address - Country:US
Mailing Address - Phone:641-322-4408
Mailing Address - Fax:
Practice Address - Street 1:2244 LOOMIS AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:IA
Practice Address - Zip Code:50841
Practice Address - Country:US
Practice Address - Phone:641-322-3737
Practice Address - Fax:641-322-3377
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice