Provider Demographics
NPI:1467697003
Name:CLINT FULKS, INC.
Entity Type:Organization
Organization Name:CLINT FULKS, INC.
Other - Org Name:FULKS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FULKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-350-4564
Mailing Address - Street 1:3316 HIGHWAY 5 N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9031
Mailing Address - Country:US
Mailing Address - Phone:501-847-6453
Mailing Address - Fax:501-847-6460
Practice Address - Street 1:1200 FERGUSON DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3503
Practice Address - Country:US
Practice Address - Phone:501-778-9222
Practice Address - Fax:501-778-9223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINT FULKS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty