| J. Glenn Rutherford Dds Pc | |
|
51 David Dr Pagosa Springs CO 81147-9440 | |
| (970) 731-3627 | |
| (970) 731-2395 |
| Full Name | J. Glenn Rutherford Dds Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 51 David Dr, Pagosa Springs, Colorado |
| Authorized Official Name and Position | Jack Glenn Rutherford (PRESIDENT) |
| Authorized Official Contact | 9707313627 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Glenn Rutherford Dds Pc 51 David Dr Pagosa Springs CO 81147-9440 Ph: (970) 731-3627 | J. Glenn Rutherford Dds Pc 51 David Dr Pagosa Springs CO 81147-9440 Ph: (970) 731-3627 |
| NPI Number | 1063610269 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 07/10/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063610269 | NPI | - | NPPES |
| 04014924 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6065 (Colorado) | Primary |
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