Provider Demographics
NPI:1457173007
Name:RIDGEFIELD DENTAL CARE LLC
Entity type:Organization
Organization Name:RIDGEFIELD DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-203-8776
Mailing Address - Street 1:5200 NE 259TH CIR
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-4803
Mailing Address - Country:US
Mailing Address - Phone:402-203-8776
Mailing Address - Fax:
Practice Address - Street 1:4312 S SETTLER DR STE 200
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-4532
Practice Address - Country:US
Practice Address - Phone:402-203-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty