Provider Demographics
NPI:1356578520
Name:FULP, SCOTT ROBISON (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROBISON
Last Name:FULP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MAGNOLIA DR N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4217
Mailing Address - Country:US
Mailing Address - Phone:229-382-7996
Mailing Address - Fax:229-386-4832
Practice Address - Street 1:215 MAGNOLIA DR N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4217
Practice Address - Country:US
Practice Address - Phone:229-382-7996
Practice Address - Fax:229-386-4832
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice