NPI 1881021020

Fullwood Dental Clinic, LLC

Organisation General Practice Dentistry Selmer, TN

Practice location

Address: 485 Mulberry Ave, Selmer, TN 38375-2307
Phone: (731) 645-7785

Authorised official

Name: Ronnie L Fullwood
Title: Dentist
Phone: (731) 645-7785

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 9500 (TN)

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Registry record

NPI: 1881021020
Entity type: Organization
NPI issued: 2 Oct 2013
Record last updated: 2 Oct 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.