MEDICARE: DR. ALAN K FULKS D.D.S., M.S.

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	10791	MI

General Provider Information

NPI Number	:	1730101064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN K FULKS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	405 NORTH BLVD
Second Line	:
City	:	KINGSFORD
State	:	MI
Zip	:	49802-4413
Country	:	US
Telephone Number	:	906-774-8490
Fax Number	:	906-774-4990

Provider Business Practice Location Address
First Line	:	405 NORTH BLVD
Second Line	:
City	:	KINGSFORD
State	:	MI
Zip	:	49802-4413
Country	:	US
Telephone Number	:	906-774-8490
Fax Number	:	906-774-4990

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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