Provider Demographics
NPI:1558165308
Name:DRDENTAL PLLC
Entity type:Organization
Organization Name:DRDENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSPINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-768-3453
Mailing Address - Street 1:2304 FOSSIL TRACE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-6149
Mailing Address - Country:US
Mailing Address - Phone:970-768-3453
Mailing Address - Fax:
Practice Address - Street 1:100 S RIDGE ST # 103
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-6498
Practice Address - Country:US
Practice Address - Phone:970-768-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty