| NPI | 1023176591 |
|---|---|
| Professional Name | GREGORY P FULLER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859342) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D2547) |
| 1223G0001X Dentist, General Practice (Licence: AZ D2547) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2022-05-05 |