Provider Demographics
NPI:1962481994
Name:TRUSHKOWSKY, RICHARD DENNIS
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DENNIS
Last Name:TRUSHKOWSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2332
Mailing Address - Country:US
Mailing Address - Phone:718-948-5808
Mailing Address - Fax:718-948-4453
Practice Address - Street 1:483 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2332
Practice Address - Country:US
Practice Address - Phone:718-948-5808
Practice Address - Fax:718-948-4453
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0290011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice