Provider Demographics
NPI:1437350766
Name:ROBERT F. FULMER, D.D.S., P.A.
Entity Type:Organization
Organization Name:ROBERT F. FULMER, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:D,DS
Authorized Official - Phone:501-268-1831
Mailing Address - Street 1:1604 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4633
Mailing Address - Country:US
Mailing Address - Phone:501-268-1831
Mailing Address - Fax:501-268-3097
Practice Address - Street 1:1604 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4633
Practice Address - Country:US
Practice Address - Phone:501-268-1831
Practice Address - Fax:501-268-3097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR24501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty