NPIMap

Organization Active NPI

Michael T. Fulbright DDS a Professional Corporation

  • Dentist
  • Redondo Beach, CA
National Provider Identifier
1669869087
Registry record updated Oct 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
47892 Issued in CA
Legal business name
MICHAEL T. FULBRIGHT DDS A PROFESSIONAL CORPORATION
Practice address
1815 Via El Prado
#200
Redondo Beach, CA 90277-5722
Phone
(310) 316-4477
NPI assigned
Apr 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2015

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

Authorized official

Name
Mr. Michael Fulbright, DDSNPI 1962545764
Title
President/Owner
Phone
(310) 316-4477

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 47892 CA Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

1815 Via El Prado
#200
Redondo Beach, CA 90277-5722

Mailing address

1815 Via El Prado
#200
Redondo Beach, CA 90277-5722
Phone (310) 316-4477

National Provider Directory

National Provider Directory

Locations

1815 Via El Prado
Ste 200
Redondo Beach, CA 90277
Phone (310) 316-4477

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1669869087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 VIA EL PRADO",
            "address_2": "#200",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775722",
            "telephone_number": "310-316-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 VIA EL PRADO",
            "address_2": "#200",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775722",
            "telephone_number": "310-316-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL T. FULBRIGHT DDS A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "FULBRIGHT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "310-316-4477",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "47892",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; 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.