Provider Demographics
NPI:1134393259
Name:FUSILLO, BRIAN A (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:FUSILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PADANARAM RD
Mailing Address - Street 2:DENTAL ASSOCIATES OF CT PC
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811
Mailing Address - Country:US
Mailing Address - Phone:203-748-5717
Mailing Address - Fax:203-748-4340
Practice Address - Street 1:ONE ASPETUCK AVE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776
Practice Address - Country:US
Practice Address - Phone:860-355-4137
Practice Address - Fax:860-355-4139
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice