Provider Demographics
NPI:1639490675
Name:FULCHI, RYAN MICHAEL (DMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:FULCHI
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 1:430 PEACHTREE DR
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-4889
Mailing Address - Country:US
Mailing Address - Phone:706-461-6781
Mailing Address - Fax:
Practice Address - Street 1:2515 HABERSHAM ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-9346
Practice Address - Country:US
Practice Address - Phone:912-234-2206
Practice Address - Fax:912-238-1522
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist