Provider Demographics
NPI:1972906428
Name:FUSION DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:FUSION DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-653-2299
Mailing Address - Street 1:9300 SE 91ST AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3762
Mailing Address - Country:US
Mailing Address - Phone:503-653-2299
Mailing Address - Fax:503-774-4154
Practice Address - Street 1:9300 SE 91ST AVE STE 403
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3762
Practice Address - Country:US
Practice Address - Phone:503-653-2299
Practice Address - Fax:503-774-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8178332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment