Provider Demographics
NPI:1962921205
Name:FULLER & ASSOCIATES, P.A.
Entity type:Organization
Organization Name:FULLER & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-343-4543
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:336-629-3113
Mailing Address - Fax:
Practice Address - Street 1:109 CONNER DR STE 2100
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7041
Practice Address - Country:US
Practice Address - Phone:919-442-1670
Practice Address - Fax:919-442-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841217296OtherNPI