Organization
BRAD T FULKERSON, DMD,MSD,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD TODD FULKERSON DMD (OWNER)
(270) 827-5522
Entity
Organization
Contact information
Practice address
700A BARRETT BLVD, HENDERSON, KY 42420-4931
(270) 827-5522
(270) 827-8272
Mailing address
700A BARRETT BLVD, P.O. BOX 276, HENDERSON, KY 42420-4931
(270) 827-5522
(270) 827-8272
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12009862
IN
1223P0221X
Pediatric Dentistry
Primary
7040
KY
Other
Enumeration date
12/05/2011
Last updated
12/05/2011
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