Provider Demographics
NPI:1508170713
Name:FULKS, DAVID B (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:FULKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1749
Mailing Address - Country:US
Mailing Address - Phone:419-228-4036
Mailing Address - Fax:419-228-6273
Practice Address - Street 1:2607 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2445
Practice Address - Country:US
Practice Address - Phone:614-237-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist