Provider Demographics
NPI:1073666566
Name:ARISCO, JUDE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:T
Last Name:ARISCO
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 1:2004B S 57TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6948
Mailing Address - Country:US
Mailing Address - Phone:254-773-2197
Mailing Address - Fax:254-773-5062
Practice Address - Street 1:2004B S 57TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6948
Practice Address - Country:US
Practice Address - Phone:254-773-2197
Practice Address - Fax:254-773-5062
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice