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General NPI Number Information
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NPI Number | 1881292845
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Entity Type | Individual
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Provider Name | MATTHEW THOMAS RURKA DMD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 300 E 5TH AVE STE 400
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City | NAPERVILLE
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State | IL
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Zip | 60563-3288
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Country | US
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Telephone | 630-369-6818
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Fax |
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Provider Business Mailing Address
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Address Line | 2465 WENDOVER DR
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City | NAPERVILLE
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State | IL
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Zip | 60565-3256
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Country | US
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Telephone | 630-209-8051
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0006824
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License Number State | AL
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