Provider Demographics
NPI:1215114780
Name:DEANA FUGATE, DMD, P.A.
Entity type:Organization
Organization Name:DEANA FUGATE, DMD, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-329-0298
Mailing Address - Street 1:13500 NC HIGHWAY 50
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-7934
Mailing Address - Country:US
Mailing Address - Phone:910-329-0298
Mailing Address - Fax:910-329-4498
Practice Address - Street 1:13500 NC HIGHWAY 50
Practice Address - Street 2:SUITE 104
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-7934
Practice Address - Country:US
Practice Address - Phone:910-329-0298
Practice Address - Fax:910-329-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8338122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326027038OtherINDIVIDUAL NPI