MEDICARE: DAVID B. FULKS DDS LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1255861621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID B. FULKS DDS LLC

Provider Business Mailing Address
First Line	:	2607 E MAIN ST
Second Line	:
City	:	BEXLEY
State	:	OH
Zip	:	43209-2445
Country	:	US
Telephone Number	:	614-237-3781
Fax Number	:	614-237-4519

Provider Business Practice Location Address
First Line	:	2607 E MAIN ST
Second Line	:
City	:	BEXLEY
State	:	OH
Zip	:	43209-2445
Country	:	US
Telephone Number	:	614-237-3781
Fax Number	:	614-237-4519

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID FULKS
Credential	:
Telephone Number	:	614-237-3781

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	07/21/2022

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