Provider Demographics
NPI:1194860536
Name:RUTHERFORD, BILLY MAURICE (DDS)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:MAURICE
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21605 PRINCE EDWARD HWY
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:VA
Mailing Address - Zip Code:23966-2487
Mailing Address - Country:US
Mailing Address - Phone:434-736-8748
Mailing Address - Fax:434-736-8419
Practice Address - Street 1:126 J ST
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23947
Practice Address - Country:US
Practice Address - Phone:434-736-8748
Practice Address - Fax:434-736-8419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010071401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice