Healthcare Provider Details

I. General information

NPI: 1205055860
Provider Name (Legal Business Name): FULTON JOSEPH ZINK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 WEBSTER ST SUITE F
FAIRFIELD CA
94533-4997
US

IV. Provider business mailing address

1525 WEBSTER ST SUITE F
FAIRFIELD CA
94533-4997
US

V. Phone/Fax

Practice location:
  • Phone: 707-426-0541
  • Fax: 707-426-0599
Mailing address:
  • Phone: 707-426-0541
  • Fax: 707-426-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number27862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: