Provider Demographics
NPI:1093913600
Name:MAINES, RALPH G JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:G
Last Name:MAINES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 TICE PL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2717
Mailing Address - Country:US
Mailing Address - Phone:980-232-3218
Mailing Address - Fax:
Practice Address - Street 1:1109 TICE PL
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2717
Practice Address - Country:US
Practice Address - Phone:980-232-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014221001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice