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General NPI Number Information
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NPI Number | 1700110384
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Entity Type | Organization
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Legal Business Name | MARYJANE L. FUSTER DMD APC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 53 MARYLINN DRIVE
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City | MILPITAS
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State | CA
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Zip | 95035-4311
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Country | US
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Telephone | 408-934-0391
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Fax | 408-934-0398
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Provider Business Mailing Address
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Address Line | 53 MARYLINN DR
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City | MILPITAS
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State | CA
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Zip | 95035-4311
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Country | US
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Telephone | 408-934-0391
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Fax | 408-934-0398
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MARYJANE L FUSTER
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Credential | DMD
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Telephone | 408-934-0391
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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 | 43786
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License Number State | CA
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