Logan Davis Rutch, DMD, MMS

Primary specialty

DentistTaxonomy code 122300000X

License

DS043311 Issued in PA

Practice address

1528 Walnut St Ste 200
Philadelphia, PA 19102-3602

Phone

(215) 999-6695

NPI assigned

Apr 7, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PA Surgery Group LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Philadelphia, PA
  • NPI 1891477162
  NPD

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1366021040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1528 WALNUT ST STE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191023602",
            "telephone_number": "570-999-6695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 WALNUT ST STE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191023602",
            "telephone_number": "215-999-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTCH",
        "first_name": "LOGAN",
        "middle_name": "DAVIS",
        "name_prefix": "Dr.",
        "credential": "DMD, MMS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-07",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS043311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefani Ann Russo, M.D.
• Jody Moser Russon, LMFT
• Donna Rust, CRNP
• Mary Antoinette Rust, DDS
• Tara Michelle Rustum, PT, DPT
• Julia Rutenberg, M.D.
• Ruth Eller'S Home Care LLC
• Corey Kades Ruth, M.D.
• Linda Ruthen, LSW
• Sarah Rebecca Ruthen, MD

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; 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.