Active NPI
David T Rudziewicz, DDS
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1962662304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1002491
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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, IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019021382 | IL | MD | Dentist |
| 1002491 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aria Dental Care PC | Dentist | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.