Provider Demographics
NPI:1851508592
Name:FUCINARI, DAVID P (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:FUCINARI
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 1:84 SCOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413
Mailing Address - Country:US
Mailing Address - Phone:989-269-2247
Mailing Address - Fax:989-658-2311
Practice Address - Street 1:2228 MAIN ST
Practice Address - Street 2:
Practice Address - City:UBLY
Practice Address - State:MI
Practice Address - Zip Code:48475
Practice Address - Country:US
Practice Address - Phone:989-658-8581
Practice Address - Fax:989-658-2311
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID136041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
V02868Medicare UPIN