Provider Demographics
NPI:1457454001
Name:FUSSELL, BRIAN ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ERIC
Last Name:FUSSELL
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:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438
Mailing Address - Country:US
Mailing Address - Phone:985-839-5630
Mailing Address - Fax:
Practice Address - Street 1:802 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70638
Practice Address - Country:US
Practice Address - Phone:985-839-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25-831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1825832Medicaid