Individual
DR. MARK CRANDALL FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
225 EAST 400 SOUTH, SPRINGVILLE, UT 84663
(801) 489-3611
Mailing address
225 EAST 400 SOUTH, SPRINGVILLE, UT 84663
(801) 489-3611
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
143367-9921
UT
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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