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General NPI Number Information
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NPI Number | 1578912713
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Entity Type | Organization
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Legal Business Name | FULTON FAMILY DENTAL, LTD.
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 1308 SUNSET AVE.
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City | WAUKEGAN
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State | IL
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Zip | 60087
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Country | US
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Telephone | 847-249-2621
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Fax | 847-249-9043
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Provider Business Mailing Address
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Address Line | 1308 SUNSET AVE.
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City | WAUKEGAN
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State | IL
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Zip | 60087
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Country | US
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Telephone | 847-249-2621
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID JAMES FULTON JR.
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Credential | D.D.S.
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Telephone | 847-249-2621
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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 | 060.002213
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License Number State | IL
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