Brad Lyle Fulkerson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN21905 Issued in MA

Practice address

41 Sparhawk St
Amesbury, MA 01913

Phone

(978) 388-3505

NPI assigned

May 18, 2007

Last updated

Jun 8, 2018By 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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 28, 2016 through Feb 29, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peak Dental Implant Solutions

  dba Amesbury Dental Associates

  • General Practice Dentistry
  • Amesbury, MA
  • NPI 1366936783
  NPD Authorized official
• Henry G. Cheney Jr., D.M.D., P.C.

  • Dentist
  • Amesbury, MA
  • NPI 1134395304
  NPD (past)
• Rodrigues Dental Associates, P.C.

  • General Practice Dentistry
  • Fall River, MA
  • NPI 1952508079
  NPD (past)

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1700094158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 WASHINGTON RD",
            "city": "RYE",
            "state": "NH",
            "postal_code": "038702439",
            "telephone_number": "617-571-6951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 SPARHAWK ST",
            "city": "AMESBURY",
            "state": "MA",
            "postal_code": "01913",
            "telephone_number": "978-388-3505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1535 South Main St",
            "address_purpose": "LOCATION",
            "city": "Fall River",
            "state": "MA",
            "postal_code": "02724",
            "country_code": "US",
            "telephone_number": "508-235-0488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULKERSON",
        "first_name": "BRAD",
        "middle_name": "LYLE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "21905",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN21905",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Francavilla
• Kelly Jean Francis
• Susan Francoeur
• Vicki Freilich
• Nicholas Arthur Frey, CNP
• Full Life Counseling LLC
• Laura Ann Da Costa Gale, LICSW
• Kerri Gallagher
• Deborrah Gallegos-Petersen, RN, FNP-BC
• Kylie Shanon Gardner, OTR/L

• General Practice Dentistry in Amesbury, MA
• Providers in Amesbury, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.