Healthcare Provider Details

I. General information

NPI: 1437573151
Provider Name (Legal Business Name): TERRANCE A. RUST DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 BECHELLI LN SUITE A
REDDING CA
96002-0119
US

IV. Provider business mailing address

2315 BECHELLI LN SUITE A
REDDING CA
96002-0119
US

V. Phone/Fax

Practice location:
  • Phone: 530-223-6000
  • Fax: 530-605-3206
Mailing address:
  • Phone: 530-223-6000
  • Fax: 530-605-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD 19525
License Number StateCA

VIII. Authorized Official

Name: DR. TERRANCE ARTHUR RUST
Title or Position: OWNER
Credential: DDS
Phone: 530-223-6000