Individual
DEBORAH L FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
21 PEACE ST, PROVIDENCE, RI 02907-1510
(401) 456-3000
(401) 456-3762
Mailing address
200 HIGH SERVICE AVE, 4TH FL MARION HALL, N PROVIDENCE, RI 02904-5113
(401) 456-3309
(401) 456-3762
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN02817
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN02817
LICENSE
RI
Enumeration date
01/02/2008
Last updated
01/02/2008
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