Provider Demographics
NPI:1477280675
Name:RUTGARD, DAVID S (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:RUTGARD
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 1:8030 EL PASEO GRANDE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3228
Mailing Address - Country:US
Mailing Address - Phone:858-922-8226
Mailing Address - Fax:
Practice Address - Street 1:1203 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1430
Practice Address - Country:US
Practice Address - Phone:619-435-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107735122400000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No122400000XDental ProvidersDenturist