Provider Demographics
NPI:1528687175
Name:MATTHEW N. FULTON, D.D.S, P.C.
Entity type:Organization
Organization Name:MATTHEW N. FULTON, D.D.S, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-569-5196
Mailing Address - Street 1:5697 WOODFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9427
Mailing Address - Country:US
Mailing Address - Phone:810-569-5196
Mailing Address - Fax:
Practice Address - Street 1:401 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-9789
Practice Address - Country:US
Practice Address - Phone:810-735-7815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental