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
122 E KINDERTON WAY # B, BERMUDA RUN, NC 27006-7303
(336) 448-3060
(336) 998-3333
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
04/05/2019
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