Provider Demographics
NPI:1518291822
Name:FULTON, ZENOVIA (DMD)
Entity Type:Individual
Prefix:
First Name:ZENOVIA
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 SOUTHSIDE BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4686
Mailing Address - Country:US
Mailing Address - Phone:904-564-1888
Mailing Address - Fax:
Practice Address - Street 1:3505 SOUTHSIDE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4686
Practice Address - Country:US
Practice Address - Phone:904-564-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist