Provider Demographics
NPI:1710617832
Name:FUSON, JULIE M (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:M
Last Name:FUSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:SAKALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDA, RDA, RDH
Mailing Address - Street 1:3 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1758
Mailing Address - Country:US
Mailing Address - Phone:732-597-4181
Mailing Address - Fax:
Practice Address - Street 1:3 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1758
Practice Address - Country:US
Practice Address - Phone:732-597-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00905000124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22HI00905000OtherSTATE DENTAL HYGIENE LICENSE