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General NPI Number Information
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NPI Number | 1407609720
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Entity Type | Organization
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Legal Business Name | THOMAS RUTNER DDS PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 1116 SKI RUN BLVD STE 1
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-9018
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Country | US
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Telephone | 530-544-3426
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5973
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City | STATELINE
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State | NV
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Zip | 89449-5973
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS ALAN RUTNER
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Credential | DDS
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Telephone | 650-996-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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