Provider Demographics
NPI:1932239647
Name:FUSSINGER, DOUGLAS CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:FUSSINGER
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 1:6026 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-8883
Mailing Address - Country:US
Mailing Address - Phone:859-586-7570
Mailing Address - Fax:859-586-7525
Practice Address - Street 1:6026 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-8883
Practice Address - Country:US
Practice Address - Phone:859-586-7570
Practice Address - Fax:859-586-7525
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist