Individual
BRENT ALAN FULKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
W9430 H LUCAS DR, IRON MOUNTAIN, MI 49801-9409
(517) 896-8130
Mailing address
W9430 H LUCAS DR, IRON MOUNTAIN, MI 49801-9409
(517) 896-8130
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901020725
MI
Other
Enumeration date
07/08/2012
Last updated
07/08/2012
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