Provider Demographics
NPI:1003485418
Name:FUSTON, MADISON PAIGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:PAIGE
Last Name:FUSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:PAIGE
Other - Last Name:TERRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 ALMEDA RD APT 526
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2129
Mailing Address - Country:US
Mailing Address - Phone:409-289-1929
Mailing Address - Fax:
Practice Address - Street 1:3140 CENTRAL MALL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8039
Practice Address - Country:US
Practice Address - Phone:409-727-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice