MEDICARE: LESLIE DANIELLE RUSHING RDH

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	124Q00000X	Dental Hygienist	DH2412	FL

General Provider Information

NPI Number	:	1356946545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE DANIELLE RUSHING RDH

Provider Business Mailing Address
First Line	:	9736 W TENNESSEE LN
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34428-9625
Country	:	US
Telephone Number	:	352-651-8187
Fax Number	:

Provider Business Practice Location Address
First Line	:	9030 W FORT ISLAND TRL STE 6
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-8011
Country	:	US
Telephone Number	:	352-795-7316
Fax Number	:

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

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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