Provider Demographics
NPI:1619099132
Name:RUZZAMENTI, JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:RUZZAMENTI
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 1:41530 ENTERPRISE CIR S
Mailing Address - Street 2:SUITE 119
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4816
Mailing Address - Country:US
Mailing Address - Phone:951-296-3358
Mailing Address - Fax:951-296-3136
Practice Address - Street 1:41530 ENTERPRISE CIR S
Practice Address - Street 2:SUITE 119
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4816
Practice Address - Country:US
Practice Address - Phone:951-296-3358
Practice Address - Fax:951-296-3136
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice