Provider Demographics
NPI:1598981854
Name:FRED T. RIDGE, DDS, PA
Entity Type:Organization
Organization Name:FRED T. RIDGE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:RIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-695-3100
Mailing Address - Street 1:115 TURNBERY WAY
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374
Mailing Address - Country:US
Mailing Address - Phone:910-695-1300
Mailing Address - Fax:910-695-3126
Practice Address - Street 1:115 TURNBERY WAY
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-695-1300
Practice Address - Fax:910-695-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty