Provider Demographics
NPI:1033358296
Name:RUSHLO, JEFFREY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:RUSHLO
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 1:800 E 73RD AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-6855
Mailing Address - Country:US
Mailing Address - Phone:303-650-5800
Mailing Address - Fax:303-650-5801
Practice Address - Street 1:800 E 73RD AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80229-6855
Practice Address - Country:US
Practice Address - Phone:303-650-5800
Practice Address - Fax:303-650-5801
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid