Ian Fuger, DMD
Individual provider Active NPI Dentist · Othello, WA
NPI 1962581405 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1962581405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DE00009463 (WA)
- Practice address
- 140 E Main Street
Othello, WA 99344 - Phone
- (509) 488-5256
- Fax
- (509) 488-9939
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00009463 | WA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE00009463 | WA | Yes |
Addresses
Primary practice location
140 E Main Street
Othello, WA 99344
Mailing address
140 E Main Street
Othello, WA 99344
Phone (509) 488-5256
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5040654 | Medicaid | WA | |
| 0164415 | Other | WA | WA ST DL&I # |
Other providers in Othello, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.