Individual
DR. ADAM FREDRICK FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3223 E 29TH STREET, DES MOINES, IA 50317
(515) 266-2128
Mailing address
3223 E 29TH STREET, DES MOINES, IA 50317
(515) 266-2128
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
08213
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0421883
—
IA
01
—
1649447
UNITED CONCORDIA
IA
Enumeration date
03/20/2007
Last updated
07/08/2007
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