Individual
DR. RICHARD BRUCE FULLER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3324 PROMENADE AVE, SUITE 101, EAGAN, MN 55121-2259
(651) 452-5511
(651) 405-0677
Mailing address
3324 PROMENADE AVE, SUITE 101, EAGAN, MN 55121-2259
(651) 452-5511
(651) 405-0677
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8774
MN
Other
Enumeration date
03/14/2006
Last updated
07/08/2007
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