Provider Demographics
NPI:1063516607
Name:RUSH, NEIL C (DMD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:C
Last Name:RUSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1548
Mailing Address - Country:US
Mailing Address - Phone:859-234-1473
Mailing Address - Fax:859-234-1473
Practice Address - Street 1:218 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1548
Practice Address - Country:US
Practice Address - Phone:859-234-1473
Practice Address - Fax:859-234-1473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY831135OtherUNITED CONCORDIA PROVIDER
KY60047560Medicaid