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Individual

DR. ANNA G FULLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
950 25TH ST STE A, OGDEN, UT 84401-6823
(801) 395-7090
Mailing address
1148 E HIGHWAY 193, LAYTON, UT 84040-8528
(801) 771-4505

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8211338-9922
UT
122300000X
Dentist
DD2990
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8211338-992
UTAH DENTAL LICENCE - ANESTHESIA CLASS II PERMIT
UT
01
DD2990
NM DENTAL LICENCE
NM
Enumeration date
06/09/2008
Last updated
05/13/2020
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