Provider Demographics
NPI:1891899811
Name:FULMER, CHAD COLEMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:COLEMAN
Last Name:FULMER
Suffix:
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 1:4055 SERAPH DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3361
Mailing Address - Country:US
Mailing Address - Phone:501-329-7668
Mailing Address - Fax:501-329-2077
Practice Address - Street 1:4055 SERAPH DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3361
Practice Address - Country:US
Practice Address - Phone:501-329-7668
Practice Address - Fax:501-329-2077
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics