Healthcare Provider Details

I. General information

NPI: 1841237476
Provider Name (Legal Business Name): DEMETRIS ESTELLA RUSH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 PLEASANT HILL RD SUITE 1
DULUTH GA
30096-1429
US

IV. Provider business mailing address

1905 SCENIC HWY N STE 510
SNELLVILLE GA
30078-5635
US

V. Phone/Fax

Practice location:
  • Phone: 770-497-0110
  • Fax: 770-497-0580
Mailing address:
  • Phone: 770-979-6400
  • Fax: 770-979-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN012595
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: