MEDICARE: CHANG RUTTENCUTTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1336954502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANG RUTTENCUTTER PC

Provider Business Mailing Address
First Line	:	845 WAGNER RD
Second Line	:	C/O JEFF RUTTENCUTTER
City	:	GLENVIEW
State	:	IL
Zip	:	60025
Country	:	US
Telephone Number	:	312-952-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	9147 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2120
Country	:	US
Telephone Number	:	312-952-7005
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY RUTTENCUTTER
Credential	:	DDS PHD
Telephone Number	:	312-952-7005

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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Directions to “CHANG RUTTENCUTTER PC ” Practice Location

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