Provider Demographics
NPI:1174753420
Name:FUSELIER, MARY SEAWELL (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SEAWELL
Last Name:FUSELIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11219 READVILL LANE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739
Mailing Address - Country:US
Mailing Address - Phone:512-301-7975
Mailing Address - Fax:512-288-6506
Practice Address - Street 1:7225 W HWY 71
Practice Address - Street 2:SUITE C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8350
Practice Address - Country:US
Practice Address - Phone:512-288-0522
Practice Address - Fax:512-288-6506
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry