Provider Demographics
NPI:1679734115
Name:LUSH, GEORGE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:LUSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:E
Other - Last Name:LUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-0183
Mailing Address - Country:US
Mailing Address - Phone:860-283-9700
Mailing Address - Fax:
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1747
Practice Address - Country:US
Practice Address - Phone:860-283-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice