Provider Demographics
NPI:1730100934
Name:FUGARO, ORLANDO JOSEPH (DDS,MSD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:JOSEPH
Last Name:FUGARO
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10417
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0417
Mailing Address - Country:US
Mailing Address - Phone:206-842-2646
Mailing Address - Fax:206-842-6475
Practice Address - Street 1:710 ERICKSEN AVE NE
Practice Address - Street 2:SUITE 200
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:206-842-6475
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABF9246415OtherDEA