Provider Demographics
NPI:1205348026
Name:FUGERE DENTAL PLLC
Entity type:Organization
Organization Name:FUGERE DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGERE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-885-8997
Mailing Address - Street 1:2320 DALARNA CT NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7590
Mailing Address - Country:US
Mailing Address - Phone:801-885-8997
Mailing Address - Fax:
Practice Address - Street 1:19500 10TH AVE NE STE 210
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6553
Practice Address - Country:US
Practice Address - Phone:360-394-4337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
WADE-606250161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty