MEDICARE: DR. ROBERT L 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	122300000X	Dentist	15143	OH

General Provider Information

NPI Number	:	1659405520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L FULTON DDS

Provider Business Mailing Address
First Line	:	1756 PORTAGE TRL
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1739
Country	:	US
Telephone Number	:	330-929-5610
Fax Number	:	330-929-5610

Provider Business Practice Location Address
First Line	:	1756 PORTAGE TRL
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1739
Country	:	US
Telephone Number	:	330-929-5610
Fax Number	:	330-929-5610

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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