Provider Demographics
NPI:1871765594
Name:AUSTIN R. RUST DMD PC
Entity type:Organization
Organization Name:AUSTIN R. RUST DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:ROZIER
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-674-4674
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:LICKING
Mailing Address - State:MO
Mailing Address - Zip Code:65542-0239
Mailing Address - Country:US
Mailing Address - Phone:573-674-4674
Mailing Address - Fax:573-674-4674
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LICKING
Practice Address - State:MO
Practice Address - Zip Code:65542-9325
Practice Address - Country:US
Practice Address - Phone:573-674-4674
Practice Address - Fax:573-674-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty