Provider Demographics
NPI:1346256252
Name:GOLD, RODNEY JENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:JENE
Last Name:GOLD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 N WILMOT
Mailing Address - Street 2:STE A-2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1712
Mailing Address - Country:US
Mailing Address - Phone:520-790-9100
Mailing Address - Fax:520-790-0809
Practice Address - Street 1:899 N WILMOT
Practice Address - Street 2:STE A-2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1712
Practice Address - Country:US
Practice Address - Phone:520-790-9100
Practice Address - Fax:520-790-0809
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD3398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ092578OtherAHCCCS