=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609932078
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD C FUGLER DDS , MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 10/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 ABNER JACKSON PKWY STE A
-----------------------------------------------------
City | LAKE JACKSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-299-6878
-----------------------------------------------------
Fax | 979-299-6166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 ABNER JACKSON PKWY STE A
-----------------------------------------------------
City | LAKE JACKSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-299-6878
-----------------------------------------------------
Fax | 979-299-6166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number | K6850
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 16829
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------