Provider Demographics
NPI:1861502437
Name:RUEHS, KELLEY JO (DDS)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:JO
Last Name:RUEHS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2113
Mailing Address - Country:US
Mailing Address - Phone:319-277-4600
Mailing Address - Fax:319-266-5270
Practice Address - Street 1:1301 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2113
Practice Address - Country:US
Practice Address - Phone:319-277-4600
Practice Address - Fax:319-266-5270
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1178137Medicaid
IA1178137Medicaid