Provider Demographics
NPI:1104211424
Name:CARRUTH, JEVIN (DMD)
Entity Type:Individual
Prefix:
First Name:JEVIN
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-1329
Mailing Address - Country:US
Mailing Address - Phone:802-363-8892
Mailing Address - Fax:
Practice Address - Street 1:2 SPRING ST
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:VT
Practice Address - Zip Code:05488-1329
Practice Address - Country:US
Practice Address - Phone:802-363-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01199011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice