Institute for the Treatment of Craniofacial Pain, PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

INSTITUTE FOR THE TREATMENT OF CRANIOFACIAL PAIN, PA

Practice address

2122 E Robinson St
Orlando, FL 32803-6047

Phone

(407) 963-0553

Fax

(407) 637-5183

NPI assigned

Feb 7, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Brian D. Fuselier, DDS

Title

Owner

Phone

(407) 963-0553

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1549497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1952866600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 PRESERVE POINT DR",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895939",
            "telephone_number": "407-963-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 E ROBINSON ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328036047",
            "telephone_number": "407-963-0553",
            "fax_number": "407-637-5183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR THE TREATMENT OF CRANIOFACIAL PAIN, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-07",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "FUSELIER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-963-0553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMS",
            "identifier": "1700859063",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMS",
            "identifier": "1265405518",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Orlando, FL
• Providers in Orlando, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.