Individual
DR. TRICIA M FUSSELL
Active
Individual
DR. TRICIA M FUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S,M.S.
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN012181
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN012181
STATE LICENSE NUMBER
GA
Enumeration date
03/29/2011
Last updated
03/29/2011
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