Provider Demographics
NPI:1568247203
Name:FULBRIGHT AND FAIST DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:FULBRIGHT AND FAIST DENTAL PARTNERSHIP
Other - Org Name:FULBRIGHT COSMETIC & RECONSTRUCTIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-316-4477
Mailing Address - Street 1:1815 VIA EL PRADO, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-316-4477
Mailing Address - Fax:310-316-4475
Practice Address - Street 1:1815 VIA EL PRADO, SUITE 200
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-316-4477
Practice Address - Fax:310-316-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment