Provider Demographics
NPI:1841679453
Name:RUSCITTO, ANTONINO NICOLA (DDS)
Entity type:Individual
Prefix:MR
First Name:ANTONINO
Middle Name:NICOLA
Last Name:RUSCITTO
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 1:17300 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886
Mailing Address - Country:US
Mailing Address - Phone:714-996-1212
Mailing Address - Fax:
Practice Address - Street 1:17300 YORBA LINDA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-996-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist