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NPI Code Detail

MEDICARE: DR. CLAYTON MATTHEW FULKS DMD

MEDICARE: DR. CLAYTON MATTHEW FULKS DMD
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
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryDS0000009092TN

General Provider Information

NPI Number : 1457594038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLAYTON MATTHEW FULKS DMD
Provider Business Mailing Address
First Line : 118 MAPLE ROW BLVD STE B
Second Line :
City : HENDERSONVILLE
State : TN
Zip : 37075-3824
Country : US
Telephone Number : 615-824-8929
Fax Number :
Provider Business Practice Location Address
First Line : 118 MAPLE ROW BLVD STE B
Second Line :
City : HENDERSONVILLE
State : TN
Zip : 37075-3824
Country : US
Telephone Number : 615-824-8929
Fax Number : 615-822-3330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2009
Last Update Date : 10/24/2018

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