=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548480700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS E. FULTON, D.D.S., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 E DAYTON YELLOW SPRINGS RD
-----------------------------------------------------
City | FAIRBORN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45324-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-879-1321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 E DAYTON YELLOW SPRINGS RD
-----------------------------------------------------
City | FAIRBORN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45324-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-879-1321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MRS. PAULA K. FULTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-879-1321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------