David Rustamzadeh, DDS, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

55256 Issued in CA

Practice address

3050 E. 16TH St.
Oakland, CA 94601-2319

Phone

(510) 535-2319

Fax

(510) 535-4283

NPI assigned

Nov 30, 2006

Last updated

Mar 8, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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 CA

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• La Clinica de la Raza Inc

  dba La Clinica de La Raza--Dental

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1326154360
  NPD (past)
• La Clinica de la Raza Inc

  dba La Clinica Dental at Children's Hospital Oakland

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1346262292
  NPD (past)

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1851469712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 22210",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946232210",
            "telephone_number": "510-535-4000",
            "fax_number": "510-535-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 E. 16TH ST.",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012319",
            "telephone_number": "510-535-2319",
            "fax_number": "510-535-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTAMZADEH",
        "first_name": "DAVID",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "55256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Eleni Russell
• Rose Delaine Russell, DC
• Talaisa Russell
• Jennifer Russo, MS, LEP
• Jacquelyn Carole Russum, RDN
• Emerson Brock Rustand, MD
• Joanna Carr Ruthenberg, M.D.
• Chelsea Rutherford
• Jasmine J Rutherford
• Mary Workman Rutherford, MD

• Periodontics in Oakland, CA
• Providers in Oakland, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.