Provider Demographics
NPI:1043369457
Name:RUOCCO, JOHN FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANK
Last Name:RUOCCO
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 1:3412 BANYAN WAY
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8853
Mailing Address - Country:US
Mailing Address - Phone:704-996-2245
Mailing Address - Fax:
Practice Address - Street 1:1276 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3286
Practice Address - Country:US
Practice Address - Phone:704-996-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9512122300000X
NC77381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9512OtherSOUTH CAROLINA BOARD OF DENTISTRY