Provider Demographics
NPI:1265952980
Name:FULLINGTON, JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:FULLINGTON
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 1:1730 SHEDECK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6010
Mailing Address - Country:US
Mailing Address - Phone:405-237-6453
Mailing Address - Fax:
Practice Address - Street 1:1730 SHEDECK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6010
Practice Address - Country:US
Practice Address - Phone:405-237-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist