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Individual

DAVID RUSH DEITRICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
815 RITCHIE HWY, SUITE 202, SEVERNA PARK, MD 21146
(410) 647-3883
(410) 647-0504
Mailing address
815 RITCHIE HWY, SUITE 202, SEVERNA PARK, MD 21146
(410) 647-3883
(410) 647-0504

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9419
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
180400
UNITED CONCORDIA
MD
01
2228
BLUE CROSS BLUE SHIELD
Enumeration date
10/30/2006
Last updated
07/08/2007
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