Provider Demographics
NPI:1336877299
Name:FUSION DENTAL
Entity Type:Organization
Organization Name:FUSION DENTAL
Other - Org Name:
Other - Org Type:
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:217-540-8905
Mailing Address - Street 1:7425 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5321
Mailing Address - Country:US
Mailing Address - Phone:301-652-2123
Mailing Address - Fax:301-652-4543
Practice Address - Street 1:7425 ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5321
Practice Address - Country:US
Practice Address - Phone:301-652-2123
Practice Address - Fax:301-652-4543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUSION DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty