Active NPI
Chad Coleman Fulmer, D.D.S.
- Endodontics
- Conway, AR
National Provider Identifier
1891899811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 3334
- Practice address
- 4055 Seraph Dr
Suite 4
Conway, AR 72034-3361 - Phone
- (501) 329-7668
- Fax
- (501) 329-2077
- NPI assigned
- Sep 11, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 3334 | AR | Primary |
Addresses
Primary practice location
4055 Seraph Dr
Suite 4
Conway, AR 72034-3361
Mailing address
4055 Seraph Dr
Suite 4
Conway, AR 72034-3361
Phone (501) 329-7668
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3334 | AR | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891899811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4055 SERAPH DR",
"address_2": "SUITE 4",
"city": "CONWAY",
"state": "AR",
"postal_code": "720343361",
"telephone_number": "501-329-7668",
"fax_number": "501-329-2077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4055 SERAPH DR",
"address_2": "SUITE 4",
"city": "CONWAY",
"state": "AR",
"postal_code": "720343361",
"telephone_number": "501-329-7668",
"fax_number": "501-329-2077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULMER",
"first_name": "CHAD",
"middle_name": "COLEMAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "AR",
"license": "3334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.