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General NPI Number Information
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NPI Number | 1134393259
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Entity Type | Individual
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Provider Name | BRIAN A FUSILLO DMD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | ONE ASPETUCK AVE
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City | NEW MILFORD
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State | CT
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Zip | 06776
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Country | US
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Telephone | 860-355-4137
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Fax | 860-355-4139
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Provider Business Mailing Address
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Address Line | 36 PADANARAM RD DENTAL ASSOCIATES OF CT PC
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City | DANBURY
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State | CT
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Zip | 06811
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Country | US
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Telephone | 203-748-5717
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Fax | 203-748-4340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 009836
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License Number State | CT
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