Individual
DR. ELLIS LAMAR FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
114 TIMBERLACHEN CIR, LAKE MARY, FL 32746-3395
(407) 330-3801
(407) 330-5739
Mailing address
1287 BLESSING ST, MAITLAND, FL 32751-4260
(407) 838-0101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15405
FL
Other
Enumeration date
07/26/2006
Last updated
06/26/2012
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