Provider Demographics
NPI:1154672897
Name:CRISTINA L RUST DMD LLC
Entity Type:Organization
Organization Name:CRISTINA L RUST DMD LLC
Other - Org Name:CEDAR CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-646-1811
Mailing Address - Street 1:11786 SW BARNES RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5925
Mailing Address - Country:US
Mailing Address - Phone:503-646-1811
Mailing Address - Fax:503-924-1698
Practice Address - Street 1:11786 SW BARNES RD
Practice Address - Street 2:SUITE 360
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5925
Practice Address - Country:US
Practice Address - Phone:503-646-1811
Practice Address - Fax:503-924-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD-9483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty