Provider Demographics
NPI:1356946545
Name:RUSHING, LESLIE DANIELLE (RDH)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DANIELLE
Last Name:RUSHING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9736 W TENNESSEE LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-9625
Mailing Address - Country:US
Mailing Address - Phone:352-651-8187
Mailing Address - Fax:
Practice Address - Street 1:9030 W FORT ISLAND TRL STE 6
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8011
Practice Address - Country:US
Practice Address - Phone:352-795-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH2412124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist