Individual
DR. KATLYN ELIZABETH FULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
150 STUART XING NE, CLEVELAND, TN 37312-4065
(423) 472-9930
Mailing address
150 STUART XING NE, CLEVELAND, TN 37312-4065
(423) 476-2160
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
11554
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2019
Last updated
06/23/2021
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