Provider Demographics
NPI:1558558973
Name:RUST, ROBERT GLEN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLEN
Last Name:RUST
Suffix:JR
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 1:358 E 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3404
Mailing Address - Country:US
Mailing Address - Phone:541-342-1072
Mailing Address - Fax:541-342-2618
Practice Address - Street 1:358 E 40TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3404
Practice Address - Country:US
Practice Address - Phone:541-342-1072
Practice Address - Fax:541-342-2618
Is Sole Proprietor?:No
Enumeration Date:2007-09-30
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR54351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice