Provider Demographics
NPI:1245368851
Name:PEACE, RUSH ABBOTT SR (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSH
Middle Name:ABBOTT
Last Name:PEACE
Suffix:SR
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 1:127 LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3007
Mailing Address - Country:US
Mailing Address - Phone:478-743-1000
Mailing Address - Fax:
Practice Address - Street 1:127 LAMAR ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3007
Practice Address - Country:US
Practice Address - Phone:478-743-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN006353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist