Provider Demographics
NPI:1235521485
Name:RIDGE DENTAL CENTER
Entity Type:Organization
Organization Name:RIDGE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-764-7575
Mailing Address - Street 1:7131 N. RIDGE BLVD.
Mailing Address - Street 2:RIDGE DENTAL CENTER, STOREFRONT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:773-764-7575
Mailing Address - Fax:773-764-2951
Practice Address - Street 1:7131 N. RIDGE BLVD.
Practice Address - Street 2:RIDGE DENTAL CENTER, STOREFRONT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:773-764-7575
Practice Address - Fax:773-764-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty