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General NPI Number Information
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NPI Number | 1114535234
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Entity Type | Individual
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Provider Name | CODY RUSH DDS
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Gender | Male
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2916 W STOLLEY PARK RD STE B
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City | GRAND ISLAND
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State | NE
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Zip | 68801-6808
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Country | US
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Telephone | 308-382-6660
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Fax |
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Provider Business Mailing Address
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Address Line | 311 RENEE RD
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City | DONIPHAN
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State | NE
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Zip | 68832-9797
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Country | US
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Telephone | 308-530-1876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7641
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7641
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License Number State | NE
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