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General NPI Number Information
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NPI Number | 1356116768
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Entity Type | Organization
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Legal Business Name | RUTLAND DENTAL LLC
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 517 E RUTLAND ST
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City | COVINGTON
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State | LA
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Zip | 70433-3218
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Country | US
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Telephone | 985-892-0881
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Fax |
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Provider Business Mailing Address
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Address Line | 103 SE CENTRAL AVE
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City | AMITE
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State | LA
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Zip | 70422-2837
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Country | US
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Telephone | 985-286-4045
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TROY M VERGES
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Credential |
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Telephone | 985-892-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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