Provider Demographics
NPI:1538315528
Name:RUST, BRIAN TYSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TYSON
Last Name:RUST
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 1:11673 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2928
Mailing Address - Country:US
Mailing Address - Phone:503-644-8080
Mailing Address - Fax:503-644-8454
Practice Address - Street 1:11673 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2928
Practice Address - Country:US
Practice Address - Phone:503-644-8080
Practice Address - Fax:503-644-8454
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist