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General NPI Number Information
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NPI Number | 1982804134
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Entity Type | Individual
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Provider Name | JAMES CHARLES FULMER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 7137 236TH AVENUE SUITE 108
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City | SALEM
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State | WI
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Zip | 53168-8808
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Country | US
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Telephone | 262-843-4643
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Fax |
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Provider Business Mailing Address
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Address Line | 7137 236TH AVENUE SUITE 108
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City | SALEM
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State | WI
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Zip | 53168-8808
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Country | US
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Telephone | 262-843-4643
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3667
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License Number State | WI
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