Provider Demographics
NPI:1174194591
Name:RUTH, CHELSEY (DDS)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:RUTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:
Other - Last Name:WERDEHAUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1081 DOVE RUN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3500
Mailing Address - Country:US
Mailing Address - Phone:859-269-4613
Mailing Address - Fax:
Practice Address - Street 1:1081 DOVE RUN RD STE 105
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3500
Practice Address - Country:US
Practice Address - Phone:859-269-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist