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General NPI Number Information
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NPI Number | 1386468403
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Entity Type | Organization
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Legal Business Name | RUTKOWSKI & FUNG, DDS, DMD, PLLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2125 GREEN VISTA DR STE 104
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City | SPARKS
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State | NV
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Zip | 89431-8515
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Country | US
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Telephone | 630-337-9037
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Fax |
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Provider Business Mailing Address
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Address Line | 2125 GREEN VISTA DR STE 104
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City | SPARKS
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State | NV
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Zip | 89431-8515
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Country | US
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Telephone | 775-674-1444
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. PHILIP RUTKOWSKI
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Credential | DDS
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Telephone | 248-217-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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