Provider Demographics
NPI:1841413473
Name:SANDRA L FULLER DDS PA
Entity type:Organization
Organization Name:SANDRA L FULLER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE FINANCIAL CORD
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-379-1207
Mailing Address - Street 1:1515 WEST CORNWALLIS DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-379-1207
Mailing Address - Fax:336-379-1733
Practice Address - Street 1:1515 WEST CORNWALLIS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-379-1207
Practice Address - Fax:336-379-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty