Individual
DR. CLINT ALLEN FULKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3305 HIGHWAY 5 N STE 1, BRYANT, AR 72019-9031
(501) 847-6453
Mailing address
3305 HIGHWAY 5 N STE 1, BRYANT, AR 72019-9031
(501) 847-6453
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR3521
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001871870
UCCI
AR
05
—
169089608
—
AR
Enumeration date
05/21/2008
Last updated
12/21/2022
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