Provider Demographics
NPI:1255861621
Name:DAVID B. FULKS DDS LLC
Entity Type:Organization
Organization Name:DAVID B. FULKS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FULKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-237-3781
Mailing Address - Street 1:2607 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2445
Mailing Address - Country:US
Mailing Address - Phone:614-237-3781
Mailing Address - Fax:614-237-4519
Practice Address - Street 1:2607 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2445
Practice Address - Country:US
Practice Address - Phone:614-237-3781
Practice Address - Fax:614-237-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty