Provider Demographics
NPI:1215276571
Name:GOODMAN, RUSH DAVID (DMD)
Entity type:Individual
Prefix:MR
First Name:RUSH
Middle Name:DAVID
Last Name:GOODMAN
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 1:8405 PERSHING DRIVE
Mailing Address - Street 2:SUITE #403
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7862
Mailing Address - Country:US
Mailing Address - Phone:310-821-3427
Mailing Address - Fax:
Practice Address - Street 1:8405 PERSHING DRIVE
Practice Address - Street 2:SUITE #403.
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7862
Practice Address - Country:US
Practice Address - Phone:310-821-3427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice