Provider Demographics
NPI:1912347022
Name:RUTLEDGE, CONOR JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CONOR
Middle Name:JORDAN
Last Name:RUTLEDGE
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 1:245 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3415
Mailing Address - Country:US
Mailing Address - Phone:251-968-4446
Mailing Address - Fax:
Practice Address - Street 1:245 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3415
Practice Address - Country:US
Practice Address - Phone:251-968-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist