Provider Demographics
NPI:1467477737
Name:RUSH, TIMOTHY AARON (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:AARON
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 1:9605 FAIRMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3127
Mailing Address - Country:US
Mailing Address - Phone:502-239-5434
Mailing Address - Fax:502-538-9304
Practice Address - Street 1:209 HIGH POINT CT STE 400
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6563
Practice Address - Country:US
Practice Address - Phone:502-538-4382
Practice Address - Fax:502-538-9304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice