Kelly Rustico

Primary specialty

DentistTaxonomy code 122300000X

License

30.025097 Issued in OH

Practice address

305 W 12TH Ave
Columbus, OH 43210-1267

Phone

(614) 292-0880

NPI assigned

Apr 7, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DRS. Wu and Palabrica, D.D.S., P.C.

  • Dentist
  • Arlington, VA
  • NPI 1801062351
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698537600000",
    "number": "1801282769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1189 LEICESTER PL",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432352181",
            "telephone_number": "614-460-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W 12TH AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101267",
            "telephone_number": "614-292-0880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Wilson Blvd Ste 620",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "VA",
            "postal_code": "222092596",
            "country_code": "US",
            "telephone_number": "703-524-0288",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4725 Market St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921024715",
            "country_code": "US",
            "telephone_number": "619-515-2420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 W 12th Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432101267",
            "country_code": "US",
            "telephone_number": "614-292-0880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSTICO",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-07",
        "last_updated": "2023-10-29",
        "certification_date": "2023-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS102193",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401414839",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.025097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Csonka Russo, CPNP-AC
• Stephanie Ann Russo, MD, PHD
• Sarah Emily Rust-Overman, MS, APRN-CNP
• Laura O'Brien Hamilton Rust
• Timothy James Robert Rust, M.D.
• Michelle Emily Ruszkiewicz, CNP
• Vivian Ruszkiewicz, CNP
• Robin Rutan, LPCCS, LSW, LICDC-CS
• Sara Marie Rutan
• Scott David Rutan, MD

• Dentist in Columbus, OH
• Providers in Columbus, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.