Lee Albert Fulsaas, D.D.S.
Individual provider Active NPI Endodontics · Aledo, TX
NPI 1336108398 · NPPES record last updated Jan 6, 2012
Key facts
- NPI
- 1336108398
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 25717 (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
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150528001977 | TX | Order and Referring Only - Other (Physician) |
3678893872 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN-15018 | FL | MD | Endodontist |
| 0401411765 | VA | MD | Endodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN-15018 | FL | |
| Endodontics | 1223E0200X | 0401411765 | VA | |
| Endodontics | 1223E0200X | 25717 | TX | Yes |
Addresses
Primary practice location
108 S Ranch House Rd
Suite 1200
Aledo, TX 76008-2691
Mailing address
108 S Ranch House Rd
Suite 1200
Aledo, TX 76008-2691
Phone (817) 441-2308
Other providers in Aledo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.