Fullerton Family Dentistry, LTD

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FULLERTON FAMILY DENTISTRY, LTD

Practice address

4725 W Fullerton Ave
Chicago, IL 60639-1817

Phone

(773) 252-5757

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Joseph J Fornal, DDS

Title

Sectretary

Phone

(773) 252-5757

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649480138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391817",
            "telephone_number": "773-252-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391817",
            "telephone_number": "773-252-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON FAMILY DENTISTRY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORNAL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SECTRETARY",
        "authorized_official_telephone_number": "773-252-5757",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary-Bianca Gabrielle Fuller
• Michael Alan Fuller, MD
• Rachel Marie Fuller, PT, DPT
• Fullerton Dental Island LLC
• Fullerton Drake Medical Center
• Fullerton Kedzie Professional Pharmacy
• Fullerton Kimball Medical & Surgical Center
• Fullerton Kimball Medical Group SC
• Fullerton Medical Surgical Center
• Fullerton MRI LLC

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.