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Organization

INSTITUTE FOR THE TREATMENT OF CRANIOFACIAL PAIN, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN D. FUSELIER DDS (OWNER)
(407) 963-0553
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1265405518
OMS
FL
01
1700859063
OMS
FL
Enumeration date
02/07/2019
Last updated
07/16/2019
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