Provider Demographics
NPI:1275797631
Name:FUGIER, ERIC L (DDS, DSO, NO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:FUGIER
Suffix:
Gender:M
Credentials:DDS, DSO, NO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 W SUNSET BLVD.
Mailing Address - Street 2:SUITE 901
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:310-859-1575
Mailing Address - Fax:310-859-1017
Practice Address - Street 1:9201 W SUNSET BLVD.
Practice Address - Street 2:SUITE 901
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:310-859-1575
Practice Address - Fax:310-859-1017
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303821223G0001X
CA37082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice