Provider Demographics
NPI:1770615973
Name:HEJAZI, RUSH (DMD)
Entity type:Individual
Prefix:
First Name:RUSH
Middle Name:
Last Name:HEJAZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ARASH
Other - Middle Name:
Other - Last Name:HEJAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:901 N PENN ST UNIT R703
Mailing Address - Street 2:R703
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3147
Mailing Address - Country:US
Mailing Address - Phone:201-707-5105
Mailing Address - Fax:
Practice Address - Street 1:901 N PENN ST UNIT R703
Practice Address - Street 2:R703
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3147
Practice Address - Country:US
Practice Address - Phone:201-707-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02311700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist