MEDICARE: DR. DAVID B FULKS 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	122300000X	Dentist	30023039	OH

General Provider Information

NPI Number	:	1508170713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID B FULKS DDS

Provider Business Mailing Address
First Line	:	2115 ALLENTOWN RD
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-1749
Country	:	US
Telephone Number	:	419-228-4036
Fax Number	:	419-228-6273

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	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	12/13/2019

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