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General NPI Number Information
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NPI Number | 1285966267
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 166 FRANKLIN AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3206
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Country | US
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Telephone | 201-652-2474
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Fax | 201-652-7916
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Provider Business Mailing Address
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Address Line | 166 FRANKLIN AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3206
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Country | US
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Telephone | 201-652-2474
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Fax | 201-652-7916
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JIN HA JOUNG
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Credential | D.M.D.
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Telephone | 201-652-2474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02373100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02373200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 22DI02373200
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License Number State | NJ
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