Provider Demographics
NPI:1730666579
Name:RIDGEWOOD DENTAL P.C.
Entity Type:Organization
Organization Name:RIDGEWOOD DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:OSTROWSKI
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-947-2922
Mailing Address - Street 1:7777 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-2458
Mailing Address - Country:US
Mailing Address - Phone:219-947-2922
Mailing Address - Fax:219-942-1876
Practice Address - Street 1:7777 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342
Practice Address - Country:US
Practice Address - Phone:219-947-2922
Practice Address - Fax:219-942-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental