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General NPI Number Information
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NPI Number | 1326208885
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Entity Type | Individual
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Provider Name | RUSTON R MUNK DMD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 300 MAIN ST
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City | NYSSA
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State | OR
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Zip | 97913-3846
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Country | US
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Telephone | 541-372-3950
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Fax | 541-372-5520
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Provider Business Mailing Address
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Address Line | 300 MAIN ST
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City | NYSSA
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State | OR
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Zip | 97913-3846
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Country | US
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Telephone | 541-372-3950
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Fax | 541-372-5520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D9099
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License Number State | OR
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