Individual
DR. BRAD LYLE FULKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
41 SPARHAWK ST, AMESBURY, MA 01913
(978) 388-3505
Mailing address
25 WASHINGTON RD, RYE, NH 03870-2439
(617) 571-6951
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
21905
MA
1223G0001X
General Practice Dentistry
Primary
DN21905
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2007
Last updated
06/08/2018
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