Provider Demographics
NPI:1093861247
Name:RUSH, RICHARD ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:RUSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 JENKINS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1296
Mailing Address - Country:US
Mailing Address - Phone:423-499-8007
Mailing Address - Fax:423-499-4918
Practice Address - Street 1:3328 JENKINS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1296
Practice Address - Country:US
Practice Address - Phone:423-499-8007
Practice Address - Fax:423-499-4918
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7033122300000X
VA0401007999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000335322OtherEHR CERTIFICATION NUMBER