Individual
PETER FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2630 CENTRAL AVE, EIELSON AFB, AK 99702-2301
(907) 377-1847
Mailing address
2630 CENTRAL AVE, EIELSON AFB, AK 99702-2301
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14004164-9926
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2024
Last updated
08/12/2025
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