Healthcare Provider Details

I. General information

NPI: 1285771287
Provider Name (Legal Business Name): HELENA RUDERMAN, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E DUNDEE RD
WHEELING IL
60090-3107
US

IV. Provider business mailing address

3609 COUNTRYSIDE LN
GLENVIEW IL
60025-3721
US

V. Phone/Fax

Practice location:
  • Phone: 847-229-1700
  • Fax:
Mailing address:
  • Phone: 847-729-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. HELENA RUDERMAN
Title or Position: OWNER
Credential:
Phone: 847-729-7316