Provider Demographics
NPI:1376613224
Name:RUSNAK, BRENT ALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALVIN
Last Name:RUSNAK
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 1:7820 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4222
Mailing Address - Country:US
Mailing Address - Phone:804-262-1060
Mailing Address - Fax:804-264-0445
Practice Address - Street 1:7820 SHRADER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4222
Practice Address - Country:US
Practice Address - Phone:804-262-1060
Practice Address - Fax:804-264-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist