Provider Demographics
NPI:1841307337
Name:FULHAM, JOHN B JR (DMD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:FULHAM
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WHITE CAP LANE
Mailing Address - Street 2:
Mailing Address - City:WEST BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668
Mailing Address - Country:US
Mailing Address - Phone:508-360-5318
Mailing Address - Fax:
Practice Address - Street 1:3854 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648
Practice Address - Country:US
Practice Address - Phone:508-428-4929
Practice Address - Fax:508-420-2943
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice