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General NPI Number Information
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NPI Number | 1700887353
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Entity Type | Organization
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Legal Business Name | VALLEY DENTAL GROUP, LLC
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 545 ISLAND RD #1A
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City | RAMSEY
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State | NJ
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Zip | 07446-2813
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Country | US
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Telephone | 201-818-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 545 ISLAND RD #1A
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City | RAMSEY
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State | NJ
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Zip | 07446-2813
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Country | US
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Telephone | 201-818-6565
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALLEN GHORASHI
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Credential | DDS
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Telephone | 201-818-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI01928100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI01967000
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License Number State | NJ
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