Individual
CAITLIN GIFFORD FULK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1049 EDGEWATER ST NW STE 100, SALEM, OR 97304-4046
(503) 820-4516
Mailing address
6209 MACKENZIE VALLEY CT, SAINT LOUIS, MO 63123-3476
(336) 414-7186
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2022024401
MO
1223P0221X
Pediatric Dentistry
041418851
VA
1223P0221X
Pediatric Dentistry
Primary
D12272
OR
Other
Enumeration date
07/03/2022
Last updated
01/09/2026
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