MEDICARE: DR. TINSUE TERRANCE FU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	46838	CA

General Provider Information

NPI Number	:	1649447624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINSUE TERRANCE FU DDS

Provider Business Mailing Address
First Line	:	8007 LAGUNA BLVD
Second Line	:	SUITE 2
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7920
Country	:	US
Telephone Number	:	916-683-8688
Fax Number	:	916-683-8988

Provider Business Practice Location Address
First Line	:	8007 LAGUNA BLVD
Second Line	:	SUITE 2
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7920
Country	:	US
Telephone Number	:	916-683-8688
Fax Number	:	916-683-8988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	09/21/2020

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