Provider Demographics
NPI:1134215882
Name:KYLE RUSH, DMD, PC
Entity type:Organization
Organization Name:KYLE RUSH, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-291-8062
Mailing Address - Street 1:306 EAST 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161
Mailing Address - Country:US
Mailing Address - Phone:706-291-8062
Mailing Address - Fax:706-236-9068
Practice Address - Street 1:306 EAST 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161
Practice Address - Country:US
Practice Address - Phone:706-291-8062
Practice Address - Fax:706-236-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty