Provider Demographics
NPI:1073065645
Name:RUSH DENTAL CLINIC
Entity Type:Organization
Organization Name:RUSH DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-354-2118
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:46 TYSON RD
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251
Mailing Address - Country:US
Mailing Address - Phone:256-354-2118
Mailing Address - Fax:
Practice Address - Street 1:46 TYSON RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251
Practice Address - Country:US
Practice Address - Phone:256-354-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3891261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental