MEDICARE: DR. RICHARD RAPHAEL RUBELING JR. DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4857	KY

General Provider Information

NPI Number	:	1063505154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD RAPHAEL RUBELING JR. DMD

Provider Business Mailing Address
First Line	:	200 EAST REYNOLDS RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1245
Country	:	US
Telephone Number	:	859-272-8912
Fax Number	:	658-271-2151

Provider Business Practice Location Address
First Line	:	200 EAST REYNOLDS RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1245
Country	:	US
Telephone Number	:	859-272-8912
Fax Number	:	658-271-2151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/16/2020

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Directions to “ DR. RICHARD RAPHAEL RUBELING JR. DMD” Practice Location

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