Healthcare Provider Details

I. General information

NPI: 1700887353
Provider Name (Legal Business Name): VALLEY DENTAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ISLAND RD #1A
RAMSEY NJ
07446-2813
US

IV. Provider business mailing address

545 ISLAND RD #1A
RAMSEY NJ
07446-2813
US

V. Phone/Fax

Practice location:
  • Phone: 201-818-6565
  • Fax:
Mailing address:
  • Phone: 201-818-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01967000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI01928100
License Number StateNJ

VIII. Authorized Official

Name: ALLEN GHORASHI
Title or Position: OWNER
Credential: DDS
Phone: 201-818-6565