Provider Demographics
NPI:1700138534
Name:FUSCO, ALFRED BRUCE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:BRUCE
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 1:526 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3746
Mailing Address - Country:US
Mailing Address - Phone:203-359-3738
Mailing Address - Fax:203-353-1715
Practice Address - Street 1:526 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3746
Practice Address - Country:US
Practice Address - Phone:203-359-3738
Practice Address - Fax:203-353-1715
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT4673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist