| South Mountain Dental Specialty Group | |
|
71 Valley St Suite103 South Orange NJ 07079 | |
| (973) 378-2070 | |
| (973) 378-8334 |
| Full Name | South Mountain Dental Specialty Group |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 71 Valley St, South Orange, New Jersey |
| Authorized Official Name and Position | Ralph C Gray (PARTNER) |
| Authorized Official Contact | 9733782070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Mountain Dental Specialty Group 71 Valley St Suite103 South Orange NJ 07079 Ph: (973) 378-2070 | South Mountain Dental Specialty Group 71 Valley St Suite103 South Orange NJ 07079 Ph: (973) 378-2070 |
| NPI Number | 1063634137 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063634137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 15383 (New Jersey) | Primary |
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