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Organization
PORT JEFFERSON DENTAL GROUP P. C.
Active
Organization
PORT JEFFERSON DENTAL GROUP P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN C RUTTER D.M.D (PRESIDENT)
(631) 473-1511
Entity
Organization
Contact information
Practice address
602 MAIN ST, PORT JEFFERSON, NY 11777-2203
(631) 473-0605
Mailing address
602 MAIN ST, PORT JEFFERSON, NY 11777-2203
(631) 473-0605
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
033761
NY
1223G0001X
General Practice Dentistry
051054
NY
Other
Enumeration date
11/20/2008
Last updated
11/20/2008
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