Healthcare Provider Details

I. General information

NPI: 1386979698
Provider Name (Legal Business Name): RYAN KEANE HURLEY D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 W SCHAUMBURG RD
SCHAUMBURG IL
60194-4065
US

IV. Provider business mailing address

1443 W SCHAUMBURG RD
SCHAUMBURG IL
60194-4065
US

V. Phone/Fax

Practice location:
  • Phone: 847-895-7393
  • Fax:
Mailing address:
  • Phone: 847-895-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.027037
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021.002322
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: