Individual
MARISSA MAY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3264 N GLASSFORD HILL RD STE A, PRESCOTT VALLEY, AZ 86314-1353
(928) 759-8000
Mailing address
6348 HARVEST MOON AVE, PRESCOTT, AZ 86305-6118
(801) 703-3783
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D011954
AZ
Other
Enumeration date
09/12/2023
Last updated
09/12/2023
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