MEDICARE: DR. ALBERT LEE CRUSH II DMD

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	4159	KY

General Provider Information

NPI Number	:	1588788038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT LEE CRUSH II DMD

Provider Business Mailing Address
First Line	:	7025 W HIGHWAY 22
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9080
Country	:	US
Telephone Number	:	502-241-9880
Fax Number	:

Provider Business Practice Location Address
First Line	:	7025 WEST HWY 22
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-9080
Country	:	US
Telephone Number	:	502-241-9880
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	04/01/2015

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