Provider Demographics
NPI:1508909136
Name:FUSTER, MARYJANE LIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARYJANE
Middle Name:LIM
Last Name:FUSTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 ROBERTSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-4335
Mailing Address - Country:US
Mailing Address - Phone:408-934-0391
Mailing Address - Fax:408-934-0398
Practice Address - Street 1:53 MARYLINN DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4311
Practice Address - Country:US
Practice Address - Phone:408-934-0391
Practice Address - Fax:408-934-0398
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist