Provider Demographics
NPI:1720556749
Name:OAK RIDGE DENTAL & SURGERY, LLC
Entity Type:Organization
Organization Name:OAK RIDGE DENTAL & SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUZAFFAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH-KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-285-3016
Mailing Address - Street 1:5815 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-2352
Mailing Address - Country:US
Mailing Address - Phone:219-285-3016
Mailing Address - Fax:
Practice Address - Street 1:5815 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2352
Practice Address - Country:US
Practice Address - Phone:219-285-3016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK RIDGE DENTAL & SURGERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty