Provider Demographics
NPI:1285966267
Name:RIDGEWOOD DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:RIDGEWOOD DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN HA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-652-2474
Mailing Address - Street 1:166 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3206
Mailing Address - Country:US
Mailing Address - Phone:201-652-2474
Mailing Address - Fax:201-652-7916
Practice Address - Street 1:166 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3206
Practice Address - Country:US
Practice Address - Phone:201-652-2474
Practice Address - Fax:201-652-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023731001223G0001X
NJ22DI023732001223P0300X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty