Provider Demographics
NPI:1962698282
Name:CRUSCO, ALBERT E (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:E
Last Name:CRUSCO
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 1:2573 STATE HWY. 522
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556
Mailing Address - Country:US
Mailing Address - Phone:575-586-0331
Mailing Address - Fax:210-928-2364
Practice Address - Street 1:2573 STATE HIGHWAY 522
Practice Address - Street 2:
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87556-8755
Practice Address - Country:US
Practice Address - Phone:575-586-0331
Practice Address - Fax:575-586-0519
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250951223G0001X
AZD60921223G0001X
NMBD220191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice