Provider Demographics
NPI:1225342314
Name:FULFORD, RAELENE FRANCES (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:RAELENE
Middle Name:FRANCES
Last Name:FULFORD
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:DR
Other - First Name:RAELENE
Other - Middle Name:FRANCES
Other - Last Name:MCDOWALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1345 PLAZA CT N
Mailing Address - Street 2:1A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3531
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:720-206-0434
Practice Address - Street 1:1701 W 72ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2721
Practice Address - Country:US
Practice Address - Phone:303-650-4460
Practice Address - Fax:720-206-0434
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56263122300000X
CODEN.00202002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist