Provider Demographics
NPI:1437356466
Name:RIDGE BLVD DENTAL PC
Entity Type:Organization
Organization Name:RIDGE BLVD DENTAL PC
Other - Org Name:CENTER FOR DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LA BATTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-745-0109
Mailing Address - Street 1:7502 RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2942
Mailing Address - Country:US
Mailing Address - Phone:718-745-0109
Mailing Address - Fax:718-745-3416
Practice Address - Street 1:7502 RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2942
Practice Address - Country:US
Practice Address - Phone:718-745-0109
Practice Address - Fax:718-745-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty