Ruther Glen Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

RUTHER GLEN DENTAL, LLC

Practice address

11073 Colonel Armstead Dr
Suite 107
Ruther Glen, VA 22546-3367

Phone

(703) 629-5847

NPI assigned

Dec 11, 2015

Organization subpart

No

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

Authorized official

Name

Joseph Kerner

Title

Director

Phone

(703) 629-5847

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1449792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449792000000",
    "number": "1235504515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11073 COLONEL ARMSTEAD DR",
            "address_2": "SUITE 107",
            "city": "RUTHER GLEN",
            "state": "VA",
            "postal_code": "225463367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11073 COLONEL ARMSTEAD DR",
            "address_2": "SUITE 107",
            "city": "RUTHER GLEN",
            "state": "VA",
            "postal_code": "225463367",
            "telephone_number": "703-629-5847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUTHER GLEN DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-11",
        "last_updated": "2015-12-11",
        "status": "A",
        "authorized_official_last_name": "KERNER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "703-629-5847"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; 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.