Provider Demographics
NPI:1467921478
Name:FULPS, AMY M (RDH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:FULPS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2537
Mailing Address - Country:US
Mailing Address - Phone:480-848-9643
Mailing Address - Fax:
Practice Address - Street 1:235 W CATALINA DR
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2537
Practice Address - Country:US
Practice Address - Phone:480-848-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5987124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist