Provider Demographics
NPI:1780653675
Name:FUSSELMAN, MERRIT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERRIT
Middle Name:
Last Name:FUSSELMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14333 KINSMAN RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-9432
Mailing Address - Country:US
Mailing Address - Phone:440-834-0003
Mailing Address - Fax:
Practice Address - Street 1:14333 KINSMAN RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:OH
Practice Address - Zip Code:44021-9432
Practice Address - Country:US
Practice Address - Phone:440-834-0003
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH188501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716416Medicaid