Individual
MIKE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4201 TUDOR CENTRE DR, SUITE 320, ANCHORAGE, AK 99508-5904
(907) 317-6070
(806) 794-1919
Mailing address
4201 TUDOR CENTRE DR, SUITE 320, ANCHORAGE, AK 99508-5904
(907) 317-6070
(806) 794-1919
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
612
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
711859
UNITED CONCORDIA
—
05
—
DD06121
—
AK
Enumeration date
02/01/2007
Last updated
07/31/2007
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