Provider Demographics
NPI:1669687943
Name:RUTKAUSKAS, JOHN S (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:RUTKAUSKAS
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 1:800 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4314
Mailing Address - Country:US
Mailing Address - Phone:630-794-0051
Mailing Address - Fax:
Practice Address - Street 1:800 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4314
Practice Address - Country:US
Practice Address - Phone:630-794-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice