Healthcare Provider Details

I. General information

NPI: 1699014530
Provider Name (Legal Business Name): MATTHEW LINDON RUSHING D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3954 EASTEX FWY
BEAUMONT TX
77703-1814
US

IV. Provider business mailing address

3954 EASTEX FWY
BEAUMONT TX
77703-1814
US

V. Phone/Fax

Practice location:
  • Phone: 409-434-4121
  • Fax: 888-371-0515
Mailing address:
  • Phone: 409-434-4121
  • Fax: 888-371-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number27432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: