| Michael T. Fulbright Dds A Professional Corporation | |
|
1815 Via El Prado #200 Redondo Beach CA 90277-5722 | |
| (310) 316-4477 | |
| Not Available |
| Full Name | Michael T. Fulbright Dds A Professional Corporation |
|---|---|
| Speciality | Dentist |
| Location | 1815 Via El Prado, Redondo Beach, California |
| Authorized Official Name and Position | Michael Fulbright (PRESIDENT/OWNER) |
| Authorized Official Contact | 3103164477 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael T. Fulbright Dds A Professional Corporation 1815 Via El Prado #200 Redondo Beach CA 90277-5722 Ph: (310) 316-4477 | Michael T. Fulbright Dds A Professional Corporation 1815 Via El Prado #200 Redondo Beach CA 90277-5722 Ph: (310) 316-4477 |
| NPI Number | 1669869087 |
|---|---|
| Provider Enumeration Date | 04/23/2015 |
| Last Update Date | 10/14/2015 |
| Medicare PECOS PAC ID | 3476862418 |
|---|---|
| Medicare Enrollment ID | O20151014001758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669869087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 47892 (California) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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