Provider Demographics
NPI:1114362043
Name:FUSILIER, JEFFREY CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:FUSILIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DENTISTA DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-3503
Mailing Address - Country:US
Mailing Address - Phone:501-922-6700
Mailing Address - Fax:501-922-6357
Practice Address - Street 1:101 DENTISTA DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-3503
Practice Address - Country:US
Practice Address - Phone:501-922-6700
Practice Address - Fax:501-922-6357
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice