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General NPI Number Information
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NPI Number | 1437448644
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Entity Type | Individual
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Provider Name | TRICIA M FUSSELL D.D.S,M.S.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 1400 BUFORD HWY STE N
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City | BUFORD
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State | GA
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Zip | 30518-8721
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Country | US
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Telephone | 770-945-2015
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Fax | 770-932-8397
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Provider Business Mailing Address
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Address Line | 1400 BUFORD HWY SUITE N
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City | BUFORD
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State | GA
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Zip | 30518-8721
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Country | US
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Telephone | 770-945-2015
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Fax | 770-932-8397
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN012181
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License Number State | GA
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