# RAELENE FULFORD DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Camp Little Tooth Pediatric Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689146920
- **Authorized official:** DR. RAELENE FRANCES FULFORD DDS (OWNER/MANAGER)
- **Authorized official phone:** (909) 771-7971

## Contact information

- **Practice address:** 110 OLD LARAMIE TRL STE 105, LAFAYETTE, CO 80026-7010
- **Practice address phone:** (909) 771-7971
- **Mailing address:** 110 OLD LARAMIE TRL STE 105, LAFAYETTE, CO 80026-7010
- **Mailing address phone:** (909) 771-7971

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/27/2018
- **Last updated:** 12/27/2018