Provider Demographics
NPI:1073035911
Name:AWAD, RUSHA G (DMD)
Entity type:Individual
Prefix:DR
First Name:RUSHA
Middle Name:G
Last Name:AWAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450100 STATE ROAD 200
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-5064
Mailing Address - Country:US
Mailing Address - Phone:904-207-4766
Mailing Address - Fax:
Practice Address - Street 1:4570 BRANDY OAK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8818
Practice Address - Country:US
Practice Address - Phone:904-207-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist