Provider Demographics
NPI:1124422043
Name:RUFF, MYLY (DDS)
Entity type:Individual
Prefix:
First Name:MYLY
Middle Name:
Last Name:RUFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MYLY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2009 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2609
Mailing Address - Country:US
Mailing Address - Phone:410-643-3888
Mailing Address - Fax:410-604-1048
Practice Address - Street 1:2009 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2609
Practice Address - Country:US
Practice Address - Phone:410-643-3888
Practice Address - Fax:410-604-1048
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17239122300000X
MD15726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist