Jack W Ruby, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A13445 Issued in IL

Practice address

6735 W 95TH St
Oak Lawn, IL 60453-2112

Phone

(708) 598-0717

Fax

(708) 598-0813

NPI assigned

Mar 21, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 4, 2016 through Feb 4, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700901196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6735 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532112",
            "telephone_number": "708-598-0717",
            "fax_number": "708-598-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532112",
            "telephone_number": "708-598-0717",
            "fax_number": "708-598-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBY",
        "first_name": "JACK",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A13445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry Michael Roy, M.D.
• Mitali Roy, MD
• Royal Home Healthcare Services , Inc.
• Richard J. Rozich, D.C.
• Brian D. Ruby, DDS
• Tohfa Manji Ruda, DO
• Sophie Addison Ruger, PHARMD
• Mitch Ruh
• Amanda Ruiz
• Kyann Rule

• General Practice Dentistry in Oak Lawn, IL
• Providers in Oak Lawn, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.