Healthcare Provider Details

I. General information

NPI: 1750723425
Provider Name (Legal Business Name): ALGIS A RUGINIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 N STATE ST
LOCKPORT IL
60441-2229
US

IV. Provider business mailing address

856 N STATE ST
LOCKPORT IL
60441-2229
US

V. Phone/Fax

Practice location:
  • Phone: 815-838-1998
  • Fax: 815-838-4263
Mailing address:
  • Phone: 815-838-1998
  • Fax: 815-838-4263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.015155
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: