John Full, D.M.D.
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Supply, NC
NPI 1174970271 · NPPES record last updated Mar 6, 2022
Key facts
- NPI
- 1174970271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 11562 (NC)
- Practice address
- 90 Medical Center Dr Ste 100
Supply, NC 28462-3669 - Phone
- (910) 269-2420
- NPI assigned
- May 18, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11562 | NC | MD | Pediatric Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 11562 | NC | Yes |
Addresses
Primary practice location
90 Medical Center Dr Ste 100
Supply, NC 28462-3669
Mailing address
90 Medical Center Dr Ste 100
Supply, NC 28462-3669
Phone (717) 817-3235
Other practice location 1
100 Woods Road
Westchester Medical Center
Valhalla, NY 10595-1702
Phone (717) 817-3235
Other providers in Supply, NC
- Edward E. Hayes M.D.LLC
- Essential Connections Consulting & Wellness Services LLC
- Kaitlyn Marie Etheridge
- Fayetteville Vamc
- Kathryn Gay Flood
- William Stewart Futch Jr.
- Galloway Sands LLC
- Galloway Sands, LLC
- Joseph Richmond Galloway Jr.
- Susan Dennie Gibble
All providers in Supply, NC · Oral and Maxillofacial Surgery (Dentist) in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.