Provider Demographics
NPI:1346396876
Name:CHESTNUT RIDGE DENTAL ASSOCIATES P.A.
Entity Type:Organization
Organization Name:CHESTNUT RIDGE DENTAL ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUFSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-391-4466
Mailing Address - Street 1:595 CHESTNUT RIDGE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7663
Mailing Address - Country:US
Mailing Address - Phone:201-391-4466
Mailing Address - Fax:201-391-0422
Practice Address - Street 1:595 CHESTNUT RIDGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-7663
Practice Address - Country:US
Practice Address - Phone:201-391-4466
Practice Address - Fax:201-391-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty