Healthcare Provider Details

I. General information

NPI: 1952405946
Provider Name (Legal Business Name): CHARLES DANIEL RUSH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#46 TYSON RD
ASHLAND AL
36251
US

IV. Provider business mailing address

PO BOX 248 #46 TYSON RD
ASHLAND AL
36251
US

V. Phone/Fax

Practice location:
  • Phone: 256-354-2118
  • Fax: 256-354-2130
Mailing address:
  • Phone: 256-354-2118
  • Fax: 256-354-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3891
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: