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General NPI Number Information
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NPI Number | 1336954502
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Entity Type | Organization
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Legal Business Name | CHANG RUTTENCUTTER PC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 9147 WAUKEGAN RD
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City | MORTON GROVE
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State | IL
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Zip | 60053-2120
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Country | US
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Telephone | 312-952-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 845 WAGNER RD C/O JEFF RUTTENCUTTER
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City | GLENVIEW
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State | IL
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Zip | 60025
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Country | US
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Telephone | 312-952-7005
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY RUTTENCUTTER
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Credential | DDS PHD
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Telephone | 312-952-7005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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