Provider Demographics
NPI:1619056892
Name:RUSHING FAMILY DENTISTRY PA
Entity Type:Organization
Organization Name:RUSHING FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-936-3430
Mailing Address - Street 1:3738 FLOWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232
Mailing Address - Country:US
Mailing Address - Phone:601-936-3430
Mailing Address - Fax:601-936-3431
Practice Address - Street 1:3738 FLOWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-936-3430
Practice Address - Fax:601-936-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04735320Medicaid
194169OtherUNITED HEALTHCARE
1614718OtherUNITED CONCORDIA