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General NPI Number Information
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NPI Number | 1558744227
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Entity Type | Organization
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Legal Business Name | RYAN RUSH DDS PLLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 383 W DRAKE RD STE 101
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City | FORT COLLINS
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State | CO
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Zip | 80526-2884
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Country | US
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Telephone | 970-223-5393
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Fax |
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Provider Business Mailing Address
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Address Line | 383 W DRAKE RD STE 101
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City | FORT COLLINS
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State | CO
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Zip | 80526-2884
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Country | US
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Telephone | 970-223-5393
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Fax |
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Authorized Official
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Title or Position | OWNER/DDS
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Name | RYAN RUSH
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Credential | D.D.S.
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Telephone | 970-223-5393
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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 | DEN.00202281
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License Number State | CO
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