CLINTON RUTHERFORD DMD NPI 1740274174

NPI Information

NPI: 1740274174
Provider Name: CLINTON RUTHERFORD, DMD
Classification: Dentist - 1223P0221X
Entity Type: Individual

Specialization: Pediatric Dentistry

Address:
6404 ROOSEVELT BLVD
PHILADELPHIA, PA
ZIP 19149
Phone: (215) 743-3700
Get Directions

Clinton Rutherford, DMD is a pediatric dentistry dentist in Philadelphia, PA. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. Clinton Rutherford, DMD NPI is 1740274174. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6404 ROOSEVELT BLVD
PHILADELPHIA, PA
ZIP 19149-943
Phone: (215) 743-3700
Fax: (215) 743-3706

The enumeration date for this NPI number is 8/31/2005 and was last updated on 8/11/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry	DS035819	PENNSYLVANIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	101136688	MEDICAID	PENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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