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General NPI Number Information
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NPI Number | 1205103728
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Entity Type | Individual
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Provider Name | LAUREN RUSH D.D.S
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Gender | Female
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 6900 E 10 MILE RD
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City | CENTER LINE
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State | MI
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Zip | 48015-1168
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Country | US
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Telephone | 586-467-0980
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Fax |
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Provider Business Mailing Address
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Address Line | 28590 TAVISTOCK TRL
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City | SOUTHFIELD
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State | MI
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Zip | 48034-5186
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Country | US
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Telephone | 248-790-5170
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901020492
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License Number State | MI
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