Provider Demographics
NPI:1275110975
Name:RUSZKIEWICZ, BRIANA LYNN (DMD)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:LYNN
Last Name:RUSZKIEWICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9230
Mailing Address - Country:US
Mailing Address - Phone:724-255-8520
Mailing Address - Fax:
Practice Address - Street 1:104 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3218
Practice Address - Country:US
Practice Address - Phone:910-875-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014175561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program