Healthcare Provider Details

I. General information

NPI: 1730844473
Provider Name (Legal Business Name): RYAN CHRISTOPHER WOITAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17W679 ROOSEVELT RD
OAKBROOK TERRACE IL
60181-3545
US

IV. Provider business mailing address

443 N IDA LN
ELMHURST IL
60126-2209
US

V. Phone/Fax

Practice location:
  • Phone: 630-932-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.033390
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: