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General NPI Number Information
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NPI Number | 1639327158
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Entity Type | Individual
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Provider Name | KIMBERLY TUSTIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 1800 VALLEY RIVER DR STE 400
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City | EUGENE
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State | OR
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Zip | 97401-6714
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Country | US
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Telephone | 541-344-6058
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Fax | 541-343-0310
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Provider Business Mailing Address
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Address Line | PO BOX 25012
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City | EUGENE
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State | OR
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Zip | 97402-0445
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Country | US
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Telephone | 541-344-6058
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Fax | 541-343-0310
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D6621
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License Number State | OR
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