Provider Demographics
NPI:1932730801
Name:FULLER & ASSOCIATES IV, PLLC
Entity Type:Organization
Organization Name:FULLER & ASSOCIATES IV, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:SPHR
Authorized Official - Phone:336-226-0855
Mailing Address - Street 1:3420 TEN-TEN ROAD, SUITE 310
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:919-342-8509
Mailing Address - Fax:
Practice Address - Street 1:3420 TEN-TEN ROAD, SUITE 310
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-342-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty