NPIMap

Organization Active NPI

Port Jefferson Dental Group P. C.

  • General Practice Dentistry
  • Port Jefferson, NY
National Provider Identifier
1093960890
Registry record updated Nov 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
033761 Issued in NY
Legal business name
PORT JEFFERSON DENTAL GROUP P. C.
Practice address
602 Main St
Port Jefferson, NY 11777-2203
Phone
(631) 473-0605
NPI assigned
Nov 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John C Rutter, D.M.DNPI 1568669117
Title
President
Phone
(631) 473-1511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 033761 NY Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 051054 NY

Addresses

Primary practice location

602 Main St
Port Jefferson, NY 11777-2203

Mailing address

602 Main St
Port Jefferson, NY 11777-2203
Phone (631) 473-0605

National Provider Directory

National Provider Directory

Locations

602 Main St
Prt Jefferson, NY 11777
Phone (631) 473-0605

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227139200000",
    "number": "1093960890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 MAIN ST",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772203",
            "telephone_number": "631-473-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MAIN ST",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772203",
            "telephone_number": "631-473-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT JEFFERSON DENTAL GROUP P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-20",
        "last_updated": "2008-11-20",
        "status": "A",
        "authorized_official_last_name": "RUTTER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-473-1511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "033761",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051054",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.