MEDICARE: DR. RYAN KEANE HURLEY D.D.S., M.S.

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	122300000X	Dentist	019.027037	IL
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	021.002322	IL

General Provider Information

NPI Number	:	1386979698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN KEANE HURLEY D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1443 W SCHAUMBURG RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-4065
Country	:	US
Telephone Number	:	847-895-7393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1443 W SCHAUMBURG RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-4065
Country	:	US
Telephone Number	:	847-895-7393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	04/11/2011

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