Provider Demographics
NPI:1477710192
Name:BRIAN A. RYBICKI, DDS, P.C.
Entity Type:Organization
Organization Name:BRIAN A. RYBICKI, DDS, P.C.
Other - Org Name:SPRING GROVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-675-1156
Mailing Address - Street 1:2450 N US HIGHWAY 12
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-8361
Mailing Address - Country:US
Mailing Address - Phone:815-675-1156
Mailing Address - Fax:
Practice Address - Street 1:2450 N US HIGHWAY 12
Practice Address - Street 2:UNIT E
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-8361
Practice Address - Country:US
Practice Address - Phone:815-675-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty