Provider Demographics
NPI:1689855413
Name:RUTLEDGE, IVEY DAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVEY
Middle Name:DAVIS
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 US HWY 11
Mailing Address - Street 2:POST OFFICE BOX 327
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146
Mailing Address - Country:US
Mailing Address - Phone:205-467-3900
Mailing Address - Fax:
Practice Address - Street 1:6324 US HWY 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146
Practice Address - Country:US
Practice Address - Phone:205-467-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice