Provider Demographics
NPI:1093235871
Name:FULMER, KALEIGH E (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALEIGH
Middle Name:E
Last Name:FULMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7038
Mailing Address - Country:US
Mailing Address - Phone:262-945-7722
Mailing Address - Fax:
Practice Address - Street 1:2909 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4641
Practice Address - Country:US
Practice Address - Phone:262-671-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist