# ROBERT C FULLER DDS & JENNIFER R FULLER DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124242912
- **Authorized official:** DR. JENNIFER R FULLER DDS (DENTIST/OWNER)
- **Authorized official phone:** (313) 864-9110

## Contact information

- **Practice address:** 334 LIVERNOIS, FERNDALE, MI 48220
- **Practice address phone:** (313) 864-9110
- **Practice address fax:** (313) 864-8750
- **Mailing address:** 334 LIVERNOIS, FERNDALE, MI 48220
- **Mailing address phone:** (313) 864-9110
- **Mailing address fax:** (313) 864-8750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 17660 | MI | Yes |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 02/16/2023