Provider Demographics
NPI:1801108485
Name:NORTH RIDGEVILLE FAMILY DENTISTRY
Entity type:Organization
Organization Name:NORTH RIDGEVILLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:AJAY
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-327-0027
Mailing Address - Street 1:35945 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6003
Mailing Address - Country:US
Mailing Address - Phone:440-327-0027
Mailing Address - Fax:440-327-1326
Practice Address - Street 1:35945 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-6003
Practice Address - Country:US
Practice Address - Phone:440-327-0027
Practice Address - Fax:440-327-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6426230001Medicare NSC