Provider Demographics
NPI:1851500458
Name:CHARLES D. FULP JR. ASSOCIATES
Entity Type:Organization
Organization Name:CHARLES D. FULP JR. ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-257-5200
Mailing Address - Street 1:1326 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2203
Mailing Address - Country:US
Mailing Address - Phone:215-257-5200
Mailing Address - Fax:215-257-9770
Practice Address - Street 1:1326 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-2203
Practice Address - Country:US
Practice Address - Phone:215-257-5200
Practice Address - Fax:215-257-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0169965L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty