Provider Demographics
NPI:1902042526
Name:RUST, SANDRA ELIZABETH (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:RUST
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 AKTIS CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4300
Mailing Address - Country:US
Mailing Address - Phone:916-521-5457
Mailing Address - Fax:916-290-0201
Practice Address - Street 1:5111 AKTIS CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4300
Practice Address - Country:US
Practice Address - Phone:916-521-5457
Practice Address - Fax:916-290-0201
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherI DON'T HAVE ANY