Provider Demographics
NPI:1790485233
Name:RIDGE ORAL SURGERY, INC
Entity Type:Organization
Organization Name:RIDGE ORAL SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHROTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:908-395-0111
Mailing Address - Street 1:175 MORRISTOWN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1657
Mailing Address - Country:US
Mailing Address - Phone:908-395-0111
Mailing Address - Fax:908-395-0108
Practice Address - Street 1:175 MORRISTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1657
Practice Address - Country:US
Practice Address - Phone:908-395-0111
Practice Address - Fax:908-395-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery