Provider Demographics
NPI:1457542177
Name:FULTON DENTAL, LLC.
Entity type:Organization
Organization Name:FULTON DENTAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KANE
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-822-3838
Mailing Address - Street 1:1000 CHESTNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2375
Mailing Address - Country:US
Mailing Address - Phone:205-822-3838
Mailing Address - Fax:205-822-0443
Practice Address - Street 1:1000 CHESTNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-2375
Practice Address - Country:US
Practice Address - Phone:205-822-3838
Practice Address - Fax:205-822-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty