Provider Demographics
NPI:1295076131
Name:RUSEN, RARES DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RARES
Middle Name:DAN
Last Name:RUSEN
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 1:1078 E HOSPITALITY LN STE A
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2863
Mailing Address - Country:US
Mailing Address - Phone:909-799-8200
Mailing Address - Fax:
Practice Address - Street 1:1078 E HOSPITALITY LN STE A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2863
Practice Address - Country:US
Practice Address - Phone:909-799-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist