Philip Rutkowski, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021002967 Issued in IL

Practice address

1514 Torrence Ave
Calumet City, IL 60409-5409

Phone

(708) 891-8569

NPI assigned

Aug 12, 2014

Last updated

Sep 12, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rutkowski & Fung, DDS, DMD, PLLC

  dba The Smile Studio

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Sparks, NV
  • NPI 1386468403
  Authorized official Same address or phone
• Meckler Dental Providers (River Oaks), LTD.

  dba DentalWorks of River Oaks

  • General Practice Dentistry
  • Calumet City, IL
  • NPI 1235101866
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1942619267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 N DESPLAINES ST APT 1614",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606612327",
            "telephone_number": "248-217-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 TORRENCE AVE",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095409",
            "telephone_number": "708-891-8569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6501 95th St",
            "address_purpose": "LOCATION",
            "city": "Chicago Ridge",
            "state": "IL",
            "postal_code": "604152632",
            "country_code": "US",
            "telephone_number": "708-422-3377",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4839 Cal Sag Rd # 310",
            "address_purpose": "LOCATION",
            "city": "Crestwood",
            "state": "IL",
            "postal_code": "604184415",
            "country_code": "US",
            "telephone_number": "708-597-9055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUTKOWSKI",
        "first_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-12",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.029938",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021002967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Calumet City, IL
• Providers in Calumet City, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.