NPIMap

Organization Active NPI

Fusion Dental

  • Dentist
  • Eldersburg, MD
National Provider Identifier
1558645663
Registry record updated Oct 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10965 Issued in MD
Legal business name
FUSION DENTAL
Doing business as
Fusion Dental
Practice address
5959 Exchange Drive
Suite 116
Eldersburg, MD 21784
Phone
(410) 795-7484
NPI assigned
Oct 7, 2011
Organization subpart
Yes
Parent organization
FUSION DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gregory R Bob, DDS
Title
PC President
Phone
(301) 843-9330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 10965 MD Primary

Addresses

Primary practice location

5959 Exchange Drive
Suite 116
Eldersburg, MD 21784

Mailing address

1137 Liberty Rd
Eldersburg, MD 21784-7934
Phone (410) 795-7484

Other names 1

  • Fusion Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Greater Maryland Dental Partners-Columbia8 organizations share this tax ID, including this one
Part of
Greater Maryland Dental Partners-Columbia

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5959 Exchange Dr
Ste 116
Eldersburg, MD 21784
Phone (433) 300-3185

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317945600000",
    "number": "1558645663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 LIBERTY RD",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217847934",
            "telephone_number": "410-795-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5959 EXCHANGE DRIVE",
            "address_2": "SUITE 116",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "21784",
            "telephone_number": "410-795-7484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUSION DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FUSION DENTAL",
        "enumeration_date": "2011-10-07",
        "last_updated": "2011-10-07",
        "status": "A",
        "authorized_official_last_name": "BOB",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PC PRESIDENT",
        "authorized_official_telephone_number": "301-843-9330",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "10965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fusion Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eldersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.