Provider Demographics
NPI:1528092863
Name:FULTON, KIMBERLY JEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JEAN
Last Name:FULTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15033 W BELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3217
Mailing Address - Country:US
Mailing Address - Phone:623-537-9100
Mailing Address - Fax:623-518-3168
Practice Address - Street 1:15033 W BELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3217
Practice Address - Country:US
Practice Address - Phone:623-537-9100
Practice Address - Fax:623-518-3168
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist