Healthcare Provider Details

I. General information

NPI: 1275797631
Provider Name (Legal Business Name): ERIC L FUGIER D.D.S., D.S.O., N.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD. SUITE 901
LOS ANGELES CA
90069
US

IV. Provider business mailing address

9201 W SUNSET BLVD. SUITE 901
LOS ANGELES CA
90069
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-1575
  • Fax: 310-859-1017
Mailing address:
  • Phone: 310-859-1575
  • Fax: 310-859-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37082
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: