Individual
LORI FULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
430 W. LOOP 1604 N., SUITE 109, SAN ANTONIO, TX 78251
(210) 647-7447
(210) 647-7839
Mailing address
430 W. LOOP 1604 N., SUITE 109, SAN ANTONIO, TX 78251
(210) 647-7447
(210) 647-7839
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22556
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47-5070043
TAX ID
TX
Enumeration date
12/11/2006
Last updated
01/23/2017
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