Individual
DR. BENJAMIN LUKE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
835 3RD AVE SW, CEDAR RAPIDS, IA 52404-1810
(319) 366-8377
(319) 366-7091
Mailing address
2825 ROSEBAY CT, CEDAR RAPIDS, IA 52411-4701
(319) 321-1486
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
08986
IA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6128
OK
Other
Enumeration date
06/25/2009
Last updated
07/02/2013
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