Provider Demographics
NPI:1336108398
Name:FULSAAS, LEE ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ALBERT
Last Name:FULSAAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:108 S RANCH HOUSE RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2691
Mailing Address - Country:US
Mailing Address - Phone:817-441-2308
Mailing Address - Fax:817-441-2298
Practice Address - Street 1:108 S RANCH HOUSE RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2691
Practice Address - Country:US
Practice Address - Phone:817-441-2308
Practice Address - Fax:817-441-2298
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN-150181223E0200X
VA04014117651223E0200X
TX257171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics