Provider Demographics
NPI:1245803691
Name:FUSCO, PATRICIA (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FUSCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:GRABOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:16212 E INDIANA AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2455
Mailing Address - Country:US
Mailing Address - Phone:509-922-3333
Mailing Address - Fax:509-922-6533
Practice Address - Street 1:16212 E INDIANA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-922-3333
Practice Address - Fax:509-922-6533
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-5284122300000X
WADE61181709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0460663OtherDEPARTMENT OF LABOR & INDUSTRIES