Provider Demographics
NPI:1558782789
Name:TIMOTHY M. RUBY DDS PLLC
Entity Type:Organization
Organization Name:TIMOTHY M. RUBY DDS PLLC
Other - Org Name:FOREST HILLS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-845-6313
Mailing Address - Street 1:921 E TINKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1537
Mailing Address - Country:US
Mailing Address - Phone:231-845-6313
Mailing Address - Fax:
Practice Address - Street 1:921 E TINKHAM AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1537
Practice Address - Country:US
Practice Address - Phone:231-845-6313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020882261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental