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General NPI Number Information
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NPI Number | 1073903860
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Entity Type | Organization
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Legal Business Name | ZENOVIA FULTON, DMD, PA
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Dates
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Enumeration Date | 01/31/2015
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Last Update Date | 01/31/2015
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Provider Practice Location Address
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Address Line | 6476 FORT CAROLINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32277-2042
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Country | US
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Telephone | 904-743-0900
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Fax | 904-743-4645
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Provider Business Mailing Address
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Address Line | 6476 FORT CAROLINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32277-2042
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Country | US
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Telephone | 904-743-0900
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Fax | 904-743-4645
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Authorized Official
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Title or Position | OWNER
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Name | DR. ZENOVIA FULTON
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Credential | DMD
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Telephone | 904-743-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN13608
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License Number State | FL
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