Provider Demographics
NPI:1063434934
Name:FUSCO, ADAM (DMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:FUSCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CROSSVILLE MEDICAL DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2500
Mailing Address - Country:US
Mailing Address - Phone:931-484-1759
Mailing Address - Fax:
Practice Address - Street 1:60 CROSSVILLE MEDICAL DR
Practice Address - Street 2:SUITE 115
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2500
Practice Address - Country:US
Practice Address - Phone:931-484-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS81771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice