Provider Demographics
NPI:1174618284
Name:FULLER, DANIEL W (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:FULLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 UNICORN LAKE BLVD # 131
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0102
Mailing Address - Country:US
Mailing Address - Phone:940-382-3834
Mailing Address - Fax:940-380-1329
Practice Address - Street 1:3323 UNICORN LAKE BLVD # 131
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0102
Practice Address - Country:US
Practice Address - Phone:940-382-3834
Practice Address - Fax:940-380-1329
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist