Provider Demographics
NPI:1154341485
Name:OAK RIDGE DENTAL GROUP, P.A.
Entity type:Organization
Organization Name:OAK RIDGE DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-341-1120
Mailing Address - Street 1:191 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8046
Mailing Address - Country:US
Mailing Address - Phone:732-341-1120
Mailing Address - Fax:732-914-0465
Practice Address - Street 1:191 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8046
Practice Address - Country:US
Practice Address - Phone:732-341-1120
Practice Address - Fax:732-914-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI192561223G0001X
NJDI97021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty