MEDICARE: RUSHELLE ANTHONY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11195	TN
2	1223G0001X	General Practice Dentistry	0598331	NY

General Provider Information

NPI Number	:	1861930059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSHELLE ANTHONY DDS

Provider Business Mailing Address
First Line	:	4155 N MOUNT JULIET RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4155 N MOUNT JULIET RD
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-3049
Country	:	US
Telephone Number	:	516-395-4740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	04/14/2022

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Directions to “ RUSHELLE ANTHONY DDS” Practice Location

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