Susan Rustvold, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6306 Issued in OR

Practice address

3600 N Interstate Ave
Portland, OR 97227-1106

Phone

(503) 331-5120

Fax

(503) 331-5118

NPI assigned

Jan 2, 2007

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609933571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1253 SE RIVER FOREST LN",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972673606",
            "telephone_number": "503-659-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 N INTERSTATE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271106",
            "telephone_number": "503-331-5120",
            "fax_number": "503-331-5118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTVOLD",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Russotto, PA-C
• Chloe Rust
• Randee L Rust, LMT
• Marivic Rustia
• Rustic Sage LLC
• Flavius Rusu
• Claire Levesque Rusunen, PSY.D.
• Rob Rusunen
• Amy Ruth, M.D.
• Douglass McDonald Ruth, M.S.W., L.C.S.W.

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.