Provider Demographics
NPI:1912045311
Name:RUSK, SHAWN PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PATRICK
Last Name:RUSK
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 1:3410 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
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice