Provider Demographics
NPI:1235693805
Name:FUSION DENTAL
Entity Type:Organization
Organization Name:FUSION DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-699-1027
Mailing Address - Street 1:2992 WALDORF MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4874
Mailing Address - Country:US
Mailing Address - Phone:301-843-9330
Mailing Address - Fax:
Practice Address - Street 1:1447 YORK RD STE 602
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6034
Practice Address - Country:US
Practice Address - Phone:410-825-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER MARYLAND DENTAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty