Organization
RAELENE FULFORD DDS PLLC
Active
Other names
Camp Little Tooth Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAELENE FRANCES FULFORD DDS (OWNER/MANAGER)
(909) 771-7971
Entity
Organization
Contact information
Practice address
110 OLD LARAMIE TRL STE 105, LAFAYETTE, CO 80026-7010
(909) 771-7971
Mailing address
110 OLD LARAMIE TRL STE 105, LAFAYETTE, CO 80026-7010
(909) 771-7971
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/27/2018
Last updated
12/27/2018
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