Provider Demographics
NPI:1073711875
Name:RICK RUTLAND, D.M.D., P.C.
Entity Type:Organization
Organization Name:RICK RUTLAND, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:RUTLAND
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-342-0015
Mailing Address - Street 1:6300 AIRPORT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3171
Mailing Address - Country:US
Mailing Address - Phone:251-342-0015
Mailing Address - Fax:251-342-0235
Practice Address - Street 1:6300 AIRPORT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3171
Practice Address - Country:US
Practice Address - Phone:251-342-0015
Practice Address - Fax:251-342-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU55355Medicare UPIN
AL1073711875Medicare Oscar/Certification
AL1073711875Medicare PIN
AL1073711875Medicare NSC