South Mountain Dental Specialty Group in South Orange - Periodontics
South Mountain Dental Specialty Group - NPI 1063634137
South Mountain Dental Specialty Group is a Periodontics in South Orange, New Jersey. South Mountain Dental Specialty Group practices all healthcare services and medical treatments related to Periodontics. The NPI Number for South Mountain Dental Specialty Group is 1063634137. The last update date is 2020-08-22.
South Mountain Dental Specialty Group's current location address is 71 Valley St, South Orange, New Jersey. You can contact this provider via phone number 9733782070 and fax number 9733788334. The mailing address for South Mountain Dental Specialty Group is 71 Valley St, South Orange, New Jersey. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | South Mountain Dental Specialty Group |
|---|---|
| Address | 71 Valley St, South Orange, New Jersey |
| Phone Number | 9733782070 |
| Fax Number | 9733788334 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PARTNER |
|---|---|
| Authorized Official Name | Gray C Ralph |
| Credentials | DDS |
| Telephone Number | 9733782070 |
NPI Number Detail
| NPI Number | 1063634137 |
|---|---|
| Provider Enumeration Date | 2007-05-02 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 71 Valley St |
|---|---|
| City | South Orange |
| State | New Jersey (NJ) |
| Post Code | 7079 |
| Phone Number | 9733782070 |
| Fax Number | 9733788334 |
Provider's Primary Taxonomy Detail
| Speciality | Periodontics |
|---|---|
| Taxonomy | 1223P0300X |
| Licence No | 15383 |
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Definition: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structure |
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Post Comment/ Review Below
What is the South Mountain Dental Specialty Group's 1063634137?
The South Mountain Dental Specialty Group's NPI (National Provider Identifier) Number is 1063634137. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of South Mountain Dental Specialty Group?
The South Mountain Dental Specialty Group is situated at 71 Valley St, in the city of South Orange, state of NJ, with the zip code 7079.
What is South Mountain Dental Specialty Group's area of expertise and its corresponding taxonomy classification?
The South Mountain Dental Specialty Group's field of specialization is Periodontics, and it falls under the taxonomy code 1223P0300X, which categorizes healthcare providers based on their areas of practice.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1063634137 to South Mountain Dental Specialty Group?
The Centers for Medicare & Medicaid Services originally issued the 1063634137 to South Mountain Dental Specialty Group on 2007-05-02.
When was the information pertaining to South Mountain Dental Specialty Group most recently updated or revised?
The details related to South Mountain Dental Specialty Group, including its address, specialty, and other relevant information, were last updated or revised on 2020-08-22.