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Individual

CECIL WILLIAM FULLER SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
203 DALLAS AVE, SELMA, AL 36701
(334) 874-4615
(334) 874-4987
Mailing address
203 DALLAS AVE, SELMA, AL 36701
(334) 874-4615
(334) 874-4987

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3164
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
92320
AL
Enumeration date
02/21/2008
Last updated
02/21/2008
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