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Organization
FULBRIGHT DENTAL GROUP, PC
Active
Organization
FULBRIGHT DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT S MATHUNY (CFO)
(800) 373-5400
Entity
Organization
Contact information
Practice address
5220 PACIFIC CONCOURSE DR, SUITE #120, LOS ANGELES, CA 90045-6277
(800) 373-5400
(888) 492-2900
Mailing address
5220 PACIFIC CONCOURSE DR, SUITE #120, LOS ANGELES, CA 90045-6277
(800) 373-5400
(888) 492-2900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47898
—
CA
Enumeration date
12/15/2008
Last updated
10/26/2022
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