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General NPI Number Information
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NPI Number | 1780990168
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Entity Type | Individual
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Provider Name | GRANT RUSSELL RUTHERFORD DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CIRCLE
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City | OCEANSIDE
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State | CA
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Zip | 92055
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Country | US
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Telephone | 760-763-7242
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 MOANA DR
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City | SAN DIEGO
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State | CA
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Zip | 92107-3910
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Country | US
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Telephone | 303-513-1361
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Fax |
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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 | 10238
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 108827
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License Number State | CA
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