Provider Demographics
NPI:1285722363
Name:FUCHS, MICHAEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:FUCHS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 ARIZONA AVE SW
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-3467
Mailing Address - Country:US
Mailing Address - Phone:605-352-1670
Mailing Address - Fax:605-352-2589
Practice Address - Street 1:2080 ARIZONA AVE SW
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-3467
Practice Address - Country:US
Practice Address - Phone:605-352-1670
Practice Address - Fax:605-352-2589
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7805840Medicaid
SD7805840Medicaid