Provider Demographics
NPI:1457513988
Name:WEST, RUSTIN A (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RUSTIN
Middle Name:A
Last Name:WEST
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W172 N9723 DIVISION ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022
Mailing Address - Country:US
Mailing Address - Phone:262-250-7787
Mailing Address - Fax:262-250-7785
Practice Address - Street 1:W172 N9723 DIVISION ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:262-250-7787
Practice Address - Fax:262-250-7785
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5963 15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist