Individual
DR. ELISABETH REBECCA FULLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
701 PARK AVE, DEPARTMENT OF DENTISTRY, MINNEAPOLIS, MN 55415-1623
(612) 873-6275
Mailing address
701 PARK AVE, DEPARTMENT OF DENTISTRY, MINNEAPOLIS, MN 55415-1623
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D13337
MN
Other
Enumeration date
04/21/2011
Last updated
05/08/2014
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