Provider Demographics
NPI:1659840924
Name:BRENT RUSNAK RIVER RUN DENTAL GREENGATE
Entity Type:Organization
Organization Name:BRENT RUSNAK RIVER RUN DENTAL GREENGATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-262-1060
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:
Practice Address - Street 1:3700 HAYDENPARK LANE
Practice Address - Street 2:MEDICAL OFFICE J
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233
Practice Address - Country:US
Practice Address - Phone:804-262-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty