Provider Demographics
NPI:1790833218
Name:FUSION DENTAL
Entity Type:Organization
Organization Name:FUSION DENTAL
Other - Org Name:FUSION DENTAL - COLUMBIA/CLARKSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:5005 SIGNAL BELL CT
Mailing Address - Street 2:STE 101
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-2606
Mailing Address - Country:US
Mailing Address - Phone:443-535-8940
Mailing Address - Fax:443-535-8947
Practice Address - Street 1:5005 SIGNAL BELL CT
Practice Address - Street 2:STE 101
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2606
Practice Address - Country:US
Practice Address - Phone:443-535-8940
Practice Address - Fax:443-535-8947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUSION DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty