Provider Demographics
NPI:1992681753
Name:DR. A RUTWIND PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR. A RUTWIND PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTWIND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:347-219-9216
Mailing Address - Street 1:8722 HOLLOWAY DR UNIT 1/2
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2306
Mailing Address - Country:US
Mailing Address - Phone:347-219-9216
Mailing Address - Fax:
Practice Address - Street 1:8722 HOLLOWAY DR UNIT 1/2
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2306
Practice Address - Country:US
Practice Address - Phone:347-219-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty