| NPI | 1215028303 |
|---|---|
| Former Legal Business Name | FULLER & SPENCER FULLER PC |
| Entity Type | Organization |
| Authorized Contact | LLEWELLYN WELSREAD Owner 703-771-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA VA0401006767) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA VA0401006762) |
| 122300000X Dentist (Licence: VA VA0401008876) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-11-10 |