Provider Demographics
NPI:1710638358
Name:DEANA FUGATE DMD PC
Entity Type:Organization
Organization Name:DEANA FUGATE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-208-5147
Mailing Address - Street 1:55623 LITTLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-8677
Mailing Address - Country:US
Mailing Address - Phone:865-208-5147
Mailing Address - Fax:
Practice Address - Street 1:1213 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-2130
Practice Address - Country:US
Practice Address - Phone:574-533-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental