Healthcare Provider Details

I. General information

NPI: 1578615506
Provider Name (Legal Business Name): ROBERT B RUYAK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 BRODHEAD RD
BETHLEHEM PA
18020-8908
US

IV. Provider business mailing address

2299 BRODHEAD RD
BETHLEHEM PA
18020-8908
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-0777
  • Fax: 610-861-8909
Mailing address:
  • Phone: 610-861-0777
  • Fax: 610-861-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS-21232-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: