MEDICARE: DR. DONALD ALLEN RUSH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16822	PA

General Provider Information

NPI Number	:	1295830255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD ALLEN RUSH DDS

Provider Business Mailing Address
First Line	:	1321 SUSQUEHANNA ROAD
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034
Country	:	US
Telephone Number	:	215-646-0960
Fax Number	:	215-646-0960

Provider Business Practice Location Address
First Line	:	1321 SUSQUEHANNA ROAD
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034
Country	:	US
Telephone Number	:	215-646-0960
Fax Number	:	215-646-0960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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