MEDICARE: JAMES C. FUSCO, D.D.S., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE015502	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	187734	OTHER	MO	DORAL DENTAL

General Provider Information

NPI Number	:	1275707135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES C. FUSCO, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	PO BOX 105
Second Line	:
City	:	HERMITAGE
State	:	MO
Zip	:	65668-0105
Country	:	US
Telephone Number	:	417-745-2134
Fax Number	:	417-745-2135

Provider Business Practice Location Address
First Line	:	303 SPRING ST
Second Line	:
City	:	HERMITAGE
State	:	MO
Zip	:	65668-0105
Country	:	US
Telephone Number	:	417-745-2134
Fax Number	:	417-745-2135

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. JAMES C FUSCO
Credential	:	D.D.S.
Telephone Number	:	417-745-2134

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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