Provider Demographics
NPI:1497143184
Name:EAKES, ELIZABETH FULMER (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:FULMER
Last Name:EAKES
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E BUTLER RD STE D
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2100
Mailing Address - Country:US
Mailing Address - Phone:864-297-1367
Mailing Address - Fax:864-676-1992
Practice Address - Street 1:105 E BUTLER RD STE D
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2100
Practice Address - Country:US
Practice Address - Phone:864-297-1367
Practice Address - Fax:864-676-1992
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics