Healthcare Provider Details

I. General information

NPI: 1053515916
Provider Name (Legal Business Name): EDGAR ALBERT RALFF JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 S BROAD ST
YARDVILLE NJ
08620-2105
US

IV. Provider business mailing address

4210 S BROAD ST
YARDVILLE NJ
08620-2105
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-4545
  • Fax: 609-585-8856
Mailing address:
  • Phone: 609-585-4545
  • Fax: 609-585-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI20387
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: