Provider Demographics
NPI:1114172699
Name:RUST, TRAVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:RUST
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 1:19808 N 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5546
Mailing Address - Country:US
Mailing Address - Phone:602-471-5450
Mailing Address - Fax:
Practice Address - Street 1:3815 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4612
Practice Address - Country:US
Practice Address - Phone:720-536-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9711122300000X
AZD008291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist