Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | R2208 | TX |
NPI | 1194024190 |
---|---|
Provider Name | Andrew M Read-Fuller |
First Address | Dallas, TX 75201-2577 |
Second Address | Dallas, TX 75246-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2011 |
Last Update Date | 17/03/2018 |