Provider Demographics
NPI:1700033065
Name:JOHN R. FUZIA, DMD, PA
Entity Type:Organization
Organization Name:JOHN R. FUZIA, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FUZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-246-6115
Mailing Address - Street 1:534 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-6206
Mailing Address - Country:US
Mailing Address - Phone:864-246-6115
Mailing Address - Fax:864-246-5577
Practice Address - Street 1:534 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-6206
Practice Address - Country:US
Practice Address - Phone:864-246-6115
Practice Address - Fax:864-246-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1530261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental