Individual
JOSHUA FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7897 BROAD RIVER RD, IRMO, SC 29063-2357
(803) 781-2439
Mailing address
1704 S CLEVELAND AVE STE 4, SIOUX FALLS, SD 57103-3903
(605) 331-5656
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9374
SC
1223G0001X
General Practice Dentistry
D1154
SD
1223G0001X
General Practice Dentistry
DDS-09435
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9374
SOUTH CAROLINA DENTAL LICENSE
SC
01
—
D1154
SOUTH DAKOTA DENTAL LICENSE
SD
01
—
DDS-09435
IOWA DENTAL LICENSE
IA
Enumeration date
06/15/2017
Last updated
07/21/2020
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