Provider Demographics
NPI:1851315428
Name:RUST, FLOYD BERNARD JR (DDS)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:BERNARD
Last Name:RUST
Suffix:JR
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 1:13341 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2056
Mailing Address - Country:US
Mailing Address - Phone:210-499-4746
Mailing Address - Fax:210-494-9578
Practice Address - Street 1:13341 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2056
Practice Address - Country:US
Practice Address - Phone:210-499-4746
Practice Address - Fax:210-494-9578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist