Provider Demographics
NPI:1083647085
Name:ANTONINO N RUSCITTO DDS INC
Entity Type:Organization
Organization Name:ANTONINO N RUSCITTO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONINO
Authorized Official - Middle Name:NICOLA
Authorized Official - Last Name:RUSCITTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-996-1212
Mailing Address - Street 1:17300 YORBA LINDA BLVD
Mailing Address - Street 2:STE E
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3810
Mailing Address - Country:US
Mailing Address - Phone:714-996-1212
Mailing Address - Fax:714-996-2687
Practice Address - Street 1:17300 YORBA LINDA BLVD
Practice Address - Street 2:STE E
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3810
Practice Address - Country:US
Practice Address - Phone:714-996-1212
Practice Address - Fax:714-996-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty