Provider Demographics
NPI:1275756900
Name:FUGATE, ERIC PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PETER
Last Name:FUGATE
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 1:155 GRAND VIS STE 7
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2138
Mailing Address - Country:US
Mailing Address - Phone:423-884-2300
Mailing Address - Fax:423-884-2981
Practice Address - Street 1:1277 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2456
Practice Address - Country:US
Practice Address - Phone:423-884-2300
Practice Address - Fax:423-884-2981
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN030497439OtherTAX ID #