MEDICARE: DR. ALMA R. FULTON 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
1	1223G0001X	General Practice Dentistry	DE15381	MO

General Provider Information

NPI Number	:	1770613481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALMA R. FULTON DMD

Provider Business Mailing Address
First Line	:	4211 BAYLESS AVE STE B
Second Line	:
City	:	AFFTON
State	:	MO
Zip	:	63123-7513
Country	:	US
Telephone Number	:	314-544-3434
Fax Number	:	314-544-3336

Provider Business Practice Location Address
First Line	:	4211 BAYLESS AVE STE B
Second Line	:
City	:	AFFTON
State	:	MO
Zip	:	63123-7513
Country	:	US
Telephone Number	:	314-544-3434
Fax Number	:	314-544-3336

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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