Provider Demographics
NPI:1740765924
Name:FUSTER, ALLISON (RDH)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:FUSTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4200
Mailing Address - Country:US
Mailing Address - Phone:850-622-3200
Mailing Address - Fax:
Practice Address - Street 1:78 LYNN DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-4200
Practice Address - Country:US
Practice Address - Phone:850-622-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH23454124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist