Healthcare Provider Details

I. General information

NPI: 1275707135
Provider Name (Legal Business Name): JAMES C. FUSCO, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SPRING ST
HERMITAGE MO
65668-0105
US

IV. Provider business mailing address

PO BOX 105
HERMITAGE MO
65668-0105
US

V. Phone/Fax

Practice location:
  • Phone: 417-745-2134
  • Fax: 417-745-2135
Mailing address:
  • Phone: 417-745-2134
  • Fax: 417-745-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE015502
License Number StateMO

VIII. Authorized Official

Name: DR. JAMES C FUSCO
Title or Position: DENTIST/OWNER
Credential: D.D.S.
Phone: 417-745-2134