Provider Demographics
NPI:1578615506
Name:RUYAK, ROBERT B (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:RUYAK
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 1:2299 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8908
Mailing Address - Country:US
Mailing Address - Phone:610-861-0777
Mailing Address - Fax:610-861-8909
Practice Address - Street 1:2299 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8908
Practice Address - Country:US
Practice Address - Phone:610-861-0777
Practice Address - Fax:610-861-8909
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-21232-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice