Healthcare Provider Details

I. General information

NPI: 1285722363
Provider Name (Legal Business Name): MICHAEL A FUCHS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 ARIZONA AVE SW
HURON SD
57350-3467
US

IV. Provider business mailing address

2080 ARIZONA AVE SW
HURON SD
57350-3467
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-1670
  • Fax: 605-352-2589
Mailing address:
  • Phone: 605-352-1670
  • Fax: 605-352-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberM432
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: