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General NPI Number Information
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NPI Number | 1215660717
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Entity Type | Individual
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Provider Name | CAITLIN GIFFORD FULK DMD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2022
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 1049 EDGEWATER ST NW STE 100
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City | SALEM
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State | OR
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Zip | 97304-4046
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Country | US
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Telephone | 503-820-4516
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Fax |
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Provider Business Mailing Address
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Address Line | 6209 MACKENZIE VALLEY CT
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City | SAINT LOUIS
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State | MO
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Zip | 63123-3476
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Country | US
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Telephone | 336-414-7186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 041418851
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D12272
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2022024401
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License Number State | MO
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