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General NPI Number Information
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NPI Number | 1558424051
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Entity Type | Individual
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Provider Name | TAD RUTLEDGE MABRY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 201 DSB SOUTH UNIVERSITY OF IOWA COLLEGE OF DENTISTRY
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City | IOWA CITY
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State | IA
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Zip | 52242-1001
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Country | US
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Telephone | 319-335-7487
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Fax | 319-353-5508
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Provider Business Mailing Address
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Address Line | 201 DSB SOUTH UNIVERSITY OF IOWA COLLEGE OF DENTISTRY
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City | IOWA CITY
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State | IA
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Zip | 52242-1001
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Country | US
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Telephone | 319-335-7487
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Fax | 319-353-5508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 74837
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40114
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4837
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License Number State | OK
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