Organization
J. GLENN RUTHERFORD DDS PC
Active
Other names
Pagosa Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK GLENN RUTHERFORD DDS (PRESIDENT)
(970) 731-3627
Entity
Organization
Contact information
Practice address
51 DAVID DR, PAGOSA SPRINGS, CO 81147-9440
(970) 731-3627
(970) 731-2395
Mailing address
51 DAVID DR, PAGOSA SPRINGS, CO 81147-9440
(970) 731-3627
(970) 731-2395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6065
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04014924
—
CO
Enumeration date
07/10/2007
Last updated
07/10/2007
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