Provider Demographics
NPI:1013041185
Name:RYBACK, KENNETH RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RAYMOND
Last Name:RYBACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 LEE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6465
Mailing Address - Country:US
Mailing Address - Phone:847-824-1026
Mailing Address - Fax:847-593-6991
Practice Address - Street 1:880 LEE ST STE 202
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6465
Practice Address - Country:US
Practice Address - Phone:847-824-1026
Practice Address - Fax:847-593-6991
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist