Individual
J GLENN RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
51 DAVID DR, PAGOSA SPRINGS, CO 81147-9440
(970) 731-3627
Mailing address
900 BLACK POWDER PL, PAGOSA SPRINGS, CO 81147-9375
(970) 731-5983
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
07/10/2006
Last updated
07/09/2007
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