Provider Demographics
NPI:1588741110
Name:FULP, CHARLES DOUGLAS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:FULP
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2203
Mailing Address - Country:US
Mailing Address - Phone:215-257-5200
Mailing Address - Fax:215-257-9770
Practice Address - Street 1:1326 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-2203
Practice Address - Country:US
Practice Address - Phone:215-257-5200
Practice Address - Fax:215-257-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016996L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice