Provider Demographics
NPI:1174728216
Name:MAATOUK, RUBA M (DDS)
Entity type:Individual
Prefix:DR
First Name:RUBA
Middle Name:M
Last Name:MAATOUK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1633
Mailing Address - Country:US
Mailing Address - Phone:224-628-1768
Mailing Address - Fax:847-239-0001
Practice Address - Street 1:6835 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2623
Practice Address - Country:US
Practice Address - Phone:847-239-0001
Practice Address - Fax:847-660-2193
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist