1851704233 NPI number — RUTLEDGE DENTAL ASSOCIATES INC.

Table of content: (NPI 1851704233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851704233 NPI number — RUTLEDGE DENTAL ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUTLEDGE DENTAL ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851704233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 PUMPKIN PATCH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOCKESSIN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19707-8941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 N CASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-1038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-220-3690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RUTLEDGE
Authorized Official First Name:
JANE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VICE PRESIDENT/SECRETARY
Authorized Official Telephone Number:
516-220-3690

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  G10001239 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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