Provider Demographics
NPI:1275522641
Name:RUTMAN, ANDREW BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BARRY
Last Name:RUTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERRICK RD
Mailing Address - Street 2:SUITE 106 EAST
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4800
Mailing Address - Country:US
Mailing Address - Phone:516-766-5558
Mailing Address - Fax:516-766-0928
Practice Address - Street 1:100 MERRICK RD
Practice Address - Street 2:SUITE 106 EAST
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4800
Practice Address - Country:US
Practice Address - Phone:516-766-5558
Practice Address - Fax:516-766-0928
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0368451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice