MEDICARE: DR. CATHERINE ODEN FULTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401006387	VA

General Provider Information

NPI Number	:	1245212786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE ODEN FULTON DDS

Provider Business Mailing Address
First Line	:	1029 WEST MERCURY BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666
Country	:	US
Telephone Number	:	757-838-2006
Fax Number	:	757-827-6590

Provider Business Practice Location Address
First Line	:	1029 WEST MERCURY BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666
Country	:	US
Telephone Number	:	757-838-2006
Fax Number	:	757-827-6590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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