Provider Demographics
NPI:1912648742
Name:RUGGIERO, MARISSA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:RUGGIERO
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 1:1299 PALMER AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3119
Mailing Address - Country:US
Mailing Address - Phone:914-227-7242
Mailing Address - Fax:
Practice Address - Street 1:32 CHURCH HILL RD STE 201
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1648
Practice Address - Country:US
Practice Address - Phone:860-935-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13416390200000X
CT136941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program