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General NPI Number Information
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NPI Number | 1992981062
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD DENTAL GROUP LLC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 75 CHESTNUT ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2501
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Country | US
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Telephone | 201-445-4808
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Fax | 201-445-2040
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Provider Business Mailing Address
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Address Line | 75 CHESTNUT ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2501
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Country | US
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Telephone | 201-445-4808
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Fax | 201-445-2040
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WARREN BOARDMAN
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Credential | DMD
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Telephone | 201-445-1060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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