Provider Demographics
NPI:1770613481
Name:FULTON, ALMA R (DMD)
Entity type:Individual
Prefix:DR
First Name:ALMA
Middle Name:R
Last Name:FULTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 BAYLESS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7513
Mailing Address - Country:US
Mailing Address - Phone:314-544-3434
Mailing Address - Fax:314-544-3336
Practice Address - Street 1:4211 BAYLESS AVE STE B
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-7513
Practice Address - Country:US
Practice Address - Phone:314-544-3434
Practice Address - Fax:314-544-3336
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE153811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice