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General NPI Number Information
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NPI Number | 1669552758
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Entity Type | Organization
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Legal Business Name | MICHAEL W FUQUA DDS
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 2202 S 77 SUNSHINE STRIP STE B
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-425-7474
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Fax | 956-425-3555
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Provider Business Mailing Address
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Address Line | 2202 S 77 SUNSHINE STRIP STE B
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-425-7474
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Fax | 956-425-3555
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL W FUQUA
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Credential | DDS
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Telephone | 956-425-7474
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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 | 16265
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License Number State | TX
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