Provider Demographics
NPI:1346290764
Name:FULLOP, JANOS T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANOS
Middle Name:T
Last Name:FULLOP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E 4TH ST
Mailing Address - Street 2:P.O. BOX 673
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-2012
Mailing Address - Country:US
Mailing Address - Phone:812-838-4841
Mailing Address - Fax:812-838-4844
Practice Address - Street 1:803 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-2012
Practice Address - Country:US
Practice Address - Phone:812-838-4841
Practice Address - Fax:812-838-4844
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010443A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice