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General NPI Number Information
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NPI Number | 1174753420
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Entity Type | Individual
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Provider Name | MARY SEAWELL FUSELIER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 7225 W HWY 71 SUITE C
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City | AUSTIN
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State | TX
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Zip | 78735-8350
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Country | US
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Telephone | 512-288-0522
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Fax | 512-288-6506
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Provider Business Mailing Address
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Address Line | 11219 READVILL LANE
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City | AUSTIN
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State | TX
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Zip | 78739
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Country | US
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Telephone | 512-301-7975
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Fax | 512-288-6506
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 19053
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License Number State | TX
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