Rustin Oscar Reidhead, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D8329 Issued in AZ

Practice address

4940 Lapalco Blvd
Marrero, LA 70072-4321

Phone

(480) 229-7595

NPI assigned

Sep 6, 2011

Last updated

Oct 17, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476662400000",
    "number": "1235410119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4940 LAPALCO BLVD",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700724321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 LAPALCO BLVD",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700724321",
            "telephone_number": "480-229-7595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIDHEAD",
        "first_name": "RUSTIN",
        "middle_name": "OSCAR",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-06",
        "last_updated": "2016-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D8329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Marrero, LA
• Providers in Marrero, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.