Provider Demographics
NPI:1043478084
Name:DT FULMER DMD PA
Entity Type:Organization
Organization Name:DT FULMER DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-297-1367
Mailing Address - Street 1:105 EAST BUTLER ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2103
Mailing Address - Country:US
Mailing Address - Phone:864-297-1367
Mailing Address - Fax:864-676-1992
Practice Address - Street 1:105 EAST BUTLER ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2103
Practice Address - Country:US
Practice Address - Phone:864-297-1367
Practice Address - Fax:864-676-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty