Provider Demographics
NPI:1073699245
Name:MARK J RUSHFORD DDS PC
Entity Type:Organization
Organization Name:MARK J RUSHFORD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-223-0441
Mailing Address - Street 1:833 SW 11TH
Mailing Address - Street 2:STE 1018
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205
Mailing Address - Country:US
Mailing Address - Phone:503-223-0441
Mailing Address - Fax:503-225-5556
Practice Address - Street 1:833 SW 11TH
Practice Address - Street 2:STE 1018
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-223-0441
Practice Address - Fax:503-225-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7314122300000X
ORD3582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty