NPIMap

Organization Active NPI

Brad T Fulkerson, DMD,MSD,LLC

  • Pediatric Dentistry
  • Henderson, KY
National Provider Identifier
1730457763
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
7040 Issued in KY
Legal business name
BRAD T FULKERSON, DMD,MSD,LLC
Practice address
700A Barrett Blvd
Henderson, KY 42420-4931
Phone
(270) 827-5522
Fax
(270) 827-8272
NPI assigned
Dec 5, 2011
Last updated
Dec 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

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

Authorized official

Name
Dr. Brad Todd Fulkerson, DMD
Title
Owner
Phone
(270) 827-5522

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 12009862 IN
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 7040 KY Primary

Addresses

Primary practice location

700A Barrett Blvd
Henderson, KY 42420-4931

Mailing address

700A Barrett Blvd
P.O. Box 276
Henderson, KY 42420-4931
Phone (270) 827-5522

National Provider Directory

National Provider Directory

Locations

700 Barret Blvd
Ste A
Henderson, KY 42420
Phone (270) 827-5522

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1730457763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700A BARRETT BLVD",
            "address_2": "P.O. BOX 276",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424204931",
            "telephone_number": "270-827-5522",
            "fax_number": "270-827-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700A BARRETT BLVD",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424204931",
            "telephone_number": "270-827-5522",
            "fax_number": "270-827-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAD T FULKERSON, DMD,MSD,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "FULKERSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-827-5522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009862",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "7040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.