Provider Demographics
NPI:1649957465
Name:RONQUILLO AGUILAR, LUSSI Y (DDS)
Entity type:Individual
Prefix:DR
First Name:LUSSI
Middle Name:Y
Last Name:RONQUILLO AGUILAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 US HIGHWAY 22 W STE 3
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8409
Mailing Address - Country:US
Mailing Address - Phone:908-364-4164
Mailing Address - Fax:
Practice Address - Street 1:2115 US HIGHWAY 22 W STE 3
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-364-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030499001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health