Active NPI
Leila Fussell
- Pediatric Dentistry
- Portsmouth, NH
National Provider Identifier
1235632498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 04718
- Practice address
- 87 Walford LN
Portsmouth, NH 03801-4765 - Phone
- (860) 604-9573
- NPI assigned
- Mar 14, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 04718 | NH | Primary |
Addresses
Primary practice location
87 Walford LN
Portsmouth, NH 03801-4765
Mailing address
175 Garfield Rd
West Hartford, CT 06107-2909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180731001586 | CT | Order and Referring Only - Dentist | 2961750468 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04718 | NH | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1235632498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 GARFIELD RD",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061072909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "87 WALFORD LN",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038014765",
"telephone_number": "860-604-9573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUSSELL",
"first_name": "LEILA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-14",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NH",
"license": "04718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portsmouth, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.