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Individual
CHARLES MICHAEL FULLEM
Active
Individual
CHARLES MICHAEL FULLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2015022255
MO
122300000X
Dentist
Primary
DS040673
PA
Other
Enumeration date
07/29/2015
Last updated
08/28/2023
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