Individual provider Active NPI

David T Rudziewicz, DDS

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1962662304
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1002491 Issued in WI
Practice address
2020 W Harrison St
Chicago, IL 60612-3741
Phone
(773) 549-0417
NPI assigned
Jun 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019021382 IL
General Practice Dentistry 1223G0001X 1002491 WI Primary

Addresses

Primary practice location

2020 W Harrison St
Chicago, IL 60612-3741

Mailing address

2020 W Harrison St
Chicago, IL 60612-3741
Phone (773) 549-0417

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230808001168 IL Practitioner - Dentist 1355522434 Reassigns benefits to 1 organization
I20230811000378 IN Practitioner - Dentist 1355522434 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019021382ILMDDentist
1002491WIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Aria Dental Care PC Dentist CurrentSince Jul 27, 2023 Accepting new patients

Locations

901 S 2nd St
Ste 201
Springfield, IL 62704
Phone (312) 560-2917

200 Byrd Way
Ste 205
Greenwood, IN 46143

8500 W 110th St
Ste 450
Overland Park, KS 66210
Phone (913) 362-1112

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1962662304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123741",
            "telephone_number": "773-549-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123741",
            "telephone_number": "773-549-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDZIEWICZ",
        "first_name": "DAVID",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019021382",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.