Provider Demographics
NPI:1538509229
Name:FUSELIER, GRACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:FUSELIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 VINTAGE DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2354
Mailing Address - Country:US
Mailing Address - Phone:504-888-9989
Mailing Address - Fax:
Practice Address - Street 1:2708 VINTAGE DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2354
Practice Address - Country:US
Practice Address - Phone:504-888-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist