Provider Demographics
NPI:1790385490
Name:PROGRESSIVE DENTAL GROUP
Entity Type:Organization
Organization Name:PROGRESSIVE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABHISHEK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-595-8632
Mailing Address - Street 1:246 N FRANKLIN TPKE STE 4
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1635
Mailing Address - Country:US
Mailing Address - Phone:201-962-8855
Mailing Address - Fax:201-660-1856
Practice Address - Street 1:246 N FRANKLIN TPKE STE 4
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1635
Practice Address - Country:US
Practice Address - Phone:201-962-8855
Practice Address - Fax:201-660-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty