Organization
TRIAD OCULAR AND FACIAL PLASTIC SURGERY PLLC
Active
Organization
TRIAD OCULAR AND FACIAL PLASTIC SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY LYNN FULLER MD, PHD (OWNER)
(336) 448-3060
Entity
Organization
Contact information
Practice address
6318 JESSIE LN, CLEMMONS, NC 27012-9887
(336) 448-3060
(336) 565-2400
Mailing address
5335 ROBINHOOD VILLAGE DR # 178, WINSTON SALEM, NC 27106-9820
(336) 448-3060
Taxonomy
Speciality
Code
Description
License number
State
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
2015-01115
NC
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
2015-01115
NC
Other
Enumeration date
04/12/2018
Last updated
07/02/2026
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