Rutherford, Clinton

Rutherford, Clinton is an individual health care provider with primary practice located at 6404 Roosevelt Blvd , Philadelphia PA 19149-2943. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Rutherford, Clinton can be contacted via phone (215) 743-3700.

Contact Information

Primary practice address
6404 Roosevelt Blvd Philadelphia PA 19149-2943
Phone: (215) 743-3700
Fax: (215) 743-3706
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X DS035819 Pennsylvania

Profile Details

NPI number 1740274174
LBN Legal business name Rutherford, Clinton
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2005
Last updated Aug 11th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740274174 NPPES
Pennsylvania MEDICAID 101136688

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