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General NPI Number Information
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NPI Number | 1497332126
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Entity Type | Individual
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Provider Name | ANTHONY JOE FUSCO DMD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2021
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 3463 US-21 SUITE 101
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City | FORT MILL
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State | SC
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Zip | 29715
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Country | US
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Telephone | 704-825-2081
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Fax |
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Provider Business Mailing Address
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Address Line | 3463 US-21 SUITE 101
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City | FORT MILL
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State | SC
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Zip | 29715
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Country | US
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Telephone | 704-825-2081
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE61295237
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10702
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License Number State | SC
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