# INSTITUTE FOR THE TREATMENT OF CRANIOFACIAL PAIN, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952866600
- **Authorized official:** DR. BRIAN D. FUSELIER DDS (OWNER)
- **Authorized official phone:** (407) 963-0553

## Contact information

- **Practice address:** 2122 E ROBINSON ST, ORLANDO, FL 32803-6047
- **Practice address phone:** (407) 963-0553
- **Practice address fax:** (407) 637-5183
- **Mailing address:** 1203 PRESERVE POINT DR, WINTER PARK, FL 32789-5939
- **Mailing address phone:** (407) 963-0553

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2019
- **Last updated:** 07/16/2019