Provider Demographics
NPI:1558982223
Name:RUBY, KENNETH TAYLOR (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:TAYLOR
Last Name:RUBY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 LEWIS BROWN DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-9707
Mailing Address - Country:US
Mailing Address - Phone:606-383-2269
Mailing Address - Fax:
Practice Address - Street 1:152 PARKERS MILL RD UNIT A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3150
Practice Address - Country:US
Practice Address - Phone:606-678-0874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY104281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program