Provider Demographics
NPI:1326208885
Name:MUNK, RUSTON R (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSTON
Middle Name:R
Last Name:MUNK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BOWER AVE
Mailing Address - Street 2:
Mailing Address - City:NYSSA
Mailing Address - State:OR
Mailing Address - Zip Code:97913-3940
Mailing Address - Country:US
Mailing Address - Phone:541-372-3950
Mailing Address - Fax:
Practice Address - Street 1:310 BOWER AVE
Practice Address - Street 2:
Practice Address - City:NYSSA
Practice Address - State:OR
Practice Address - Zip Code:97913-3940
Practice Address - Country:US
Practice Address - Phone:541-372-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice