Healthcare Provider Details

I. General information

NPI: 1912648742
Provider Name (Legal Business Name): MARISSA RUGGIERO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CHURCH HILL RD STE 201
NEWTOWN CT
06470-1648
US

IV. Provider business mailing address

1299 PALMER AVE APT 303
LARCHMONT NY
10538-3119
US

V. Phone/Fax

Practice location:
  • Phone: 860-935-6479
  • Fax:
Mailing address:
  • Phone: 914-227-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13416
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13694
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: