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General NPI Number Information
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NPI Number | 1790485233
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Entity Type | Organization
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Legal Business Name | RIDGE ORAL SURGERY, INC
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 175 MORRISTOWN RD STE 103
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-1657
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Country | US
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Telephone | 908-395-0111
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Fax | 908-395-0108
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Provider Business Mailing Address
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Address Line | 175 MORRISTOWN RD STE 103
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-1657
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Country | US
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Telephone | 908-395-0111
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Fax | 908-395-0108
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | PRAKHAR MEHROTRA
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Credential | DDS, MD
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Telephone | 908-395-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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