Provider Demographics
NPI:1215068168
Name:ADVANCED DENTAL CARE OF RIDGEFIELD
Entity type:Organization
Organization Name:ADVANCED DENTAL CARE OF RIDGEFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HONGSOK
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-941-8087
Mailing Address - Street 1:669 BROAD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1637
Mailing Address - Country:US
Mailing Address - Phone:201-941-8087
Mailing Address - Fax:201-941-8068
Practice Address - Street 1:669 BROAD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1637
Practice Address - Country:US
Practice Address - Phone:201-941-8087
Practice Address - Fax:201-941-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ21002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty