Provider Demographics
NPI:1255997250
Name:RISDILL DDS PA
Entity type:Organization
Organization Name:RISDILL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-249-0450
Mailing Address - Street 1:50 MOUNT PROSPECT AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1900
Mailing Address - Country:US
Mailing Address - Phone:973-249-0450
Mailing Address - Fax:973-405-6512
Practice Address - Street 1:50 MOUNT PROSPECT AVE STE 208
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1900
Practice Address - Country:US
Practice Address - Phone:973-249-0450
Practice Address - Fax:973-405-6512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RISDILL DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies