Fullwood Dental Clinic, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9500 Issued in TN

Legal business name

FULLWOOD DENTAL CLINIC, LLC

Practice address

485 Mulberry Ave
Selmer, TN 38375-2307

Phone

(731) 645-7785

NPI assigned

Oct 2, 2013

Last updated

Oct 2, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ronnie L Fullwood, D.D.S.NPI 1568575249

Title

Dentist

Phone

(731) 645-7785

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ronnie Lee Fullwood, DDS

  • Dentist
  • Selmer, TN
  • NPI 1568575249
  NPD (past) Authorized official
• Patrick Lee Fullwood, D.D.S.

  • Dentist
  • Selmer, TN
  • NPI 1114273802
  NPD (past)
• Reid Vinson, DDS

  • General Practice Dentistry
  • Selmer, TN
  • NPI 1508752254
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1881021020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 MULBERRY AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752307",
            "telephone_number": "731-645-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 MULBERRY AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752307",
            "telephone_number": "731-645-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLWOOD DENTAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "FULLWOOD",
        "authorized_official_first_name": "RONNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "731-645-7785",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "9500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fast Pace Medical Clinic PLLC
• Fast Pace Medical Clinic, PLLC
• Julia M Fields, APRN, PMHNP-BC
• Mark Finton, PH. D
• Kelley Nicole Fowler, NP
• Brian Fullwood, MD
• Mary Jane Fullwood, MD
• Patrick Lee Fullwood, D.D.S.
• Ronnie Lee Fullwood, DDS
• Lakshmanan Ganapathy, MD

• General Practice Dentistry in Selmer, TN
• Providers in Selmer, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.