Provider Demographics
NPI:1215024708
Name:RUTKOWSKI, JAMES LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOUIS
Last Name:RUTKOWSKI
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 1:35 SOUTH SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214
Mailing Address - Country:US
Mailing Address - Phone:814-226-8690
Mailing Address - Fax:814-226-9084
Practice Address - Street 1:35 SOUTH SECOND AVE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214
Practice Address - Country:US
Practice Address - Phone:814-226-8690
Practice Address - Fax:814-226-9084
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA195631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice