Provider Demographics
NPI:1669735841
Name:RUSINOSKI, AMY (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:RUSINOSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2706
Mailing Address - Country:US
Mailing Address - Phone:724-888-2684
Mailing Address - Fax:
Practice Address - Street 1:244 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2706
Practice Address - Country:US
Practice Address - Phone:724-888-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6214122300000X
PADS0399331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist