Individual
DR. JON GORDON FULLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
570 W 400 N, MOAB, UT 84532-2236
(435) 259-4333
(435) 259-6618
Mailing address
570 W 400 N, MOAB, UT 84532-2236
(435) 259-4333
(435) 259-6618
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
142288-9921
UT
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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