Provider Demographics
NPI:1689020018
Name:ORLANDO J FUGARO DDS MSD PS
Entity Type:Organization
Organization Name:ORLANDO J FUGARO DDS MSD PS
Other - Org Name:EAGLE HARBOR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUGARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-842-2646
Mailing Address - Street 1:710 ERICKSEN AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2835
Mailing Address - Country:US
Mailing Address - Phone:206-842-2646
Mailing Address - Fax:
Practice Address - Street 1:710 ERICKSEN AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2835
Practice Address - Country:US
Practice Address - Phone:206-842-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10104261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental