Individual
CLINTON RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6404 ROOSEVELT BLVD, PHILADELPHIA, PA 19149-2943
(215) 743-3700
(215) 743-3706
Mailing address
6404 ROOSEVELT BLVD, PHILADELPHIA, PA 19149-2943
(215) 743-3700
(215) 743-3706
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS035819
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101136688
—
PA
Enumeration date
08/31/2005
Last updated
08/11/2008
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