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General NPI Number Information
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NPI Number | 1528128626
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Entity Type | Individual
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Provider Name | LORI FULK DMD
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 430 W. LOOP 1604 N. SUITE 109
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City | SAN ANTONIO
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State | TX
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Zip | 78251
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Country | US
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Telephone | 210-647-7447
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Fax | 210-647-7839
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Provider Business Mailing Address
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Address Line | 430 W. LOOP 1604 N. SUITE 109
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City | SAN ANTONIO
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State | TX
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Zip | 78251
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Country | US
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Telephone | 210-647-7447
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Fax | 210-647-7839
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22556
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License Number State | TX
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