# FULLWOOD DENTAL CLINIC, LLC

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

## Provider details

- **NPI number:** 1881021020
- **Authorized official:** DR. RONNIE L FULLWOOD D.D.S. (DENTIST)
- **Authorized official phone:** (731) 645-7785

## Contact information

- **Practice address:** 485 MULBERRY AVE, SELMER, TN 38375-2307
- **Practice address phone:** (731) 645-7785
- **Mailing address:** 485 MULBERRY AVE, SELMER, TN 38375-2307
- **Mailing address phone:** (731) 645-7785

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 9500 | TN | Yes |

## Other

- **Enumeration date:** 10/02/2013
- **Last updated:** 10/02/2013