Provider Demographics
NPI:1750757597
Name:FUSION DENTAL
Entity type:Organization
Organization Name:FUSION DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:KALIN
Authorized Official - Last Name:LATHROP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-645-1344
Mailing Address - Street 1:14722 BALTIMORE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14722 BALTIMORE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4872
Practice Address - Country:US
Practice Address - Phone:301-843-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty