Provider Demographics
NPI:1326166604
Name:BRUSCA, ANTHONY GIACOMO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GIACOMO
Last Name:BRUSCA
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 1:1403 BIRCH
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AS
Mailing Address - Zip Code:85501
Mailing Address - Country:US
Mailing Address - Phone:928-812-6118
Mailing Address - Fax:
Practice Address - Street 1:1403 BIRCH ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1328
Practice Address - Country:US
Practice Address - Phone:928-812-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010163631223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK8045Medicaid