Provider Demographics
NPI:1154469567
Name:SHAWN P. RUSK D.D.S., INC.
Entity Type:Organization
Organization Name:SHAWN P. RUSK D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RUSK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-896-2445
Mailing Address - Street 1:3410 MCCALL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-2500
Mailing Address - Country:US
Mailing Address - Phone:559-896-2445
Mailing Address - Fax:559-896-3259
Practice Address - Street 1:3410 MCCALL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2500
Practice Address - Country:US
Practice Address - Phone:559-896-2445
Practice Address - Fax:559-896-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty