Provider Demographics
NPI:1063805471
Name:RIDGE, NAUREEN NAMBALA (DDS)
Entity type:Individual
Prefix:DR
First Name:NAUREEN
Middle Name:NAMBALA
Last Name:RIDGE
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 1:70 CRAPE MYRTLE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-8034
Mailing Address - Country:US
Mailing Address - Phone:910-567-6194
Mailing Address - Fax:910-567-5661
Practice Address - Street 1:70 CRAPE MYRTLE DR
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8034
Practice Address - Country:US
Practice Address - Phone:910-567-6194
Practice Address - Fax:910-567-5661
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice