Provider Demographics
NPI:1932277803
Name:FULTON, MATTHEW NORMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NORMAN
Last Name:FULTON
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 1:401 N BRIDGE ST
Mailing Address - Street 2:P.O. BOX 206
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9789
Mailing Address - Country:US
Mailing Address - Phone:810-735-7815
Mailing Address - Fax:810-735-1905
Practice Address - Street 1:401 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-9789
Practice Address - Country:US
Practice Address - Phone:810-735-7815
Practice Address - Fax:810-735-1905
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice