MEDICARE: JUANA CECILIA RYCKOWSKI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019032630	IL

General Provider Information

NPI Number	:	1275148413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA CECILIA RYCKOWSKI DMD

Provider Business Mailing Address
First Line	:	202 VANCINA LN
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-9531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 VANCINA LN
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-9531
Country	:	US
Telephone Number	:	815-348-9617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	11/05/2024

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