Individual
DANIEL ELLIOT FULTON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS PA
Contact information
Practice address
HWY 39 S CHURCH STREET, DEXALB, MS 39328
(601) 743-5921
(601) 743-5933
Mailing address
8457 JOHNNY BAILEY RD BAILEY MS 39320, BAILEY, MS 39320
(601) 681-6260
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1642 74
MS
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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