Provider Demographics
NPI:1992012611
Name:LUSCRI, EMILY SUZANNE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SUZANNE
Last Name:LUSCRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9120
Mailing Address - Country:US
Mailing Address - Phone:530-283-1119
Mailing Address - Fax:530-283-2319
Practice Address - Street 1:431 MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9120
Practice Address - Country:US
Practice Address - Phone:530-283-1119
Practice Address - Fax:530-283-2319
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist