Individual
CHARLES MICHAEL FULLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2250 MILLENNIUM WAY STE 101, ENOLA, PA 17025-1488
(717) 972-0031
Mailing address
2250 MILLENNIUM WAY STE 101, ENOLA, PA 17025-1488
(717) 972-0031
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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