Lee Albert Fulsaas, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

25717 Issued in TX

Practice address

108 S Ranch House Rd
Suite 1200
Aledo, TX 76008-2691

Phone

(817) 441-2308

Fax

(817) 441-2298

NPI assigned

Mar 20, 2006

Last updated

Jan 6, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325808000000",
    "number": "1336108398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 S RANCH HOUSE RD",
            "address_2": "SUITE 1200",
            "city": "ALEDO",
            "state": "TX",
            "postal_code": "760082691",
            "telephone_number": "817-441-2308",
            "fax_number": "817-441-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 S RANCH HOUSE RD",
            "address_2": "SUITE 1200",
            "city": "ALEDO",
            "state": "TX",
            "postal_code": "760082691",
            "telephone_number": "817-441-2308",
            "fax_number": "817-441-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULSAAS",
        "first_name": "LEE",
        "middle_name": "ALBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2012-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN-15018",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "0401411765",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "25717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Marie Filtz, M.D.
• Kelly Potysman Fisher, DCN, RD, LD, FNAP
• Chelsea Townsend Fogle, FNP-C
• Bobbi Foust, FNP-C
• Gina Fowler, DO
• Mary Lane Garmon, OT
• John-Wesley Gericke
• Marcus H Gleaton, O.D.
• Diana C Gonzalez
• Will Harlan Goodwin IV, D.D.S.

• Endodontics in Aledo, TX
• Providers in Aledo, TX by specialty
• Endodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.