Active NPI
Clint Fulks, Inc.
- General Practice Dentistry
- Benton, AR
National Provider Identifier
1467697003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3521
- Legal business name
- CLINT FULKS, INC.
- Doing business as
- Fulks Family Dentistry
- Practice address
- 1200 Ferguson Dr
Suite 4
Benton, AR 72015-3503 - Phone
- (501) 778-9222
- Fax
- (501) 778-9223
- NPI assigned
- Dec 11, 2008
- Organization subpart
- Yes
- Parent organization
- CLINT FULKS, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Clint Allen Fulks, DDS
- Title
- Owner
- Phone
- (501) 350-4564
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3521 | AR | Primary |
Addresses
Primary practice location
1200 Ferguson Dr
Suite 4
Benton, AR 72015-3503
Mailing address
3316 Highway 5 N
Suite 1
Bryant, AR 72019-9031
Phone (501) 847-6453
Other names 1
- Fulks Family Dentistry
National Provider Directory
National Provider Directory- Part of
- Clint Fulks Inc
Locations
3316 Highway 5 N
Ste 1
Bryant, AR 72019
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Bryant, AR
- NPI 1497912927
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228953600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1685577600000",
"number": "1467697003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3316 HIGHWAY 5 N",
"address_2": "SUITE 1",
"city": "BRYANT",
"state": "AR",
"postal_code": "720199031",
"telephone_number": "501-847-6453",
"fax_number": "501-847-6460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 FERGUSON DR",
"address_2": "SUITE 4",
"city": "BENTON",
"state": "AR",
"postal_code": "720153503",
"telephone_number": "501-778-9222",
"fax_number": "501-778-9223"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CLINT FULKS, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CLINT FULKS, INC.",
"enumeration_date": "2008-12-11",
"last_updated": "2023-06-01",
"certification_date": "2023-06-01",
"status": "A",
"authorized_official_last_name": "FULKS",
"authorized_official_first_name": "CLINT",
"authorized_official_middle_name": "ALLEN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "501-350-4564",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "AR",
"license": "3521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fulks Family Dentistry",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Fulks Family Dentistry",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.