Provider Demographics
NPI:1992365845
Name:FULTON, MEGAN MISNER (DDS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MISNER
Last Name:FULTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LOUELLA
Other - Last Name:MISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:400 RIVERWALK TER STE 250
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-5619
Mailing Address - Country:US
Mailing Address - Phone:918-988-0996
Mailing Address - Fax:
Practice Address - Street 1:1310 W WALNUT ST STE C
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3300
Practice Address - Country:US
Practice Address - Phone:479-636-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist