Provider Demographics
NPI:1699796433
Name:ALBRECHT, RUSTY MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSTY
Middle Name:MARK
Last Name:ALBRECHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9659 OLD JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6520
Mailing Address - Country:US
Mailing Address - Phone:440-358-0495
Mailing Address - Fax:440-358-0496
Practice Address - Street 1:9659 OLD JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6520
Practice Address - Country:US
Practice Address - Phone:440-358-0495
Practice Address - Fax:440-358-0496
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH194041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice