Provider Demographics
NPI:1396938890
Name:RUTZ, JAY CARSON (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:CARSON
Last Name:RUTZ
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4520 CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2308
Mailing Address - Country:US
Mailing Address - Phone:504-885-0177
Mailing Address - Fax:504-888-3581
Practice Address - Street 1:4520 CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2308
Practice Address - Country:US
Practice Address - Phone:504-885-0177
Practice Address - Fax:504-888-3581
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL670-36552OtherBCBS AL
LA$$$$$$$$$0OtherBCBS LA