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Organization

FULLWOOD DENTAL CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RONNIE L FULLWOOD D.D.S. (DENTIST)
(731) 645-7785
Entity
Organization

Contact information

Practice address
485 MULBERRY AVE, SELMER, TN 38375-2307
(731) 645-7785
Mailing address
485 MULBERRY AVE, SELMER, TN 38375-2307
(731) 645-7785

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9500
TN

Other

Enumeration date
10/02/2013
Last updated
10/02/2013
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