Individual
DR. LESLIE FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2255 N LOOP 336 W STE D, CONROE, TX 77304-3632
(936) 756-1951
Mailing address
2255 N LOOP 336 W STE D, CONROE, TX 77304-3632
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
19458
TX
Other
Enumeration date
06/26/2008
Last updated
06/26/2008
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