Provider Demographics
NPI:1144384595
Name:RUST, TERRANCE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:A
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 1:2315 BECHELLI LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0119
Mailing Address - Country:US
Mailing Address - Phone:530-223-6000
Mailing Address - Fax:530-605-3206
Practice Address - Street 1:2315 BECHELLI LN
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0119
Practice Address - Country:US
Practice Address - Phone:530-223-6000
Practice Address - Fax:530-605-3206
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD195251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB19525-01OtherDENTI-CAL
CA19525OtherDENTAL LICENSE
CAB19525-01OtherDENTI-CAL
CADS0195250Medicare UPIN