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General NPI Number Information
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NPI Number | 1730246174
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Entity Type | Individual
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Provider Name | JENELLE STERRETT-RUSHIN
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1717 AIRPORT FWY
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City | BEDFORD
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State | TX
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Zip | 76021-5731
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Country | US
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Telephone | 817-540-2223
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Fax |
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Provider Business Mailing Address
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Address Line | 650 INTERNATIONAL PKWY SUITE 100
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City | RICHARDSON
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State | TX
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Zip | 75081-6612
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Country | US
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Telephone | 817-540-2223
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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 | 19546
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License Number State | TX
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