South Mountain Dental Specialty Group

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

15383 Issued in NJ

Legal business name

SOUTH MOUNTAIN DENTAL SPECIALTY GROUP

Practice address

71 Valley St
Suite103
South Orange, NJ 07079

Phone

(973) 378-2070

Fax

(973) 378-8334

NPI assigned

May 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ralph C Gray, DDSNPI 1477671774

Title

Partner

Phone

(973) 378-2070

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ralph Charles Gray Sr., DDS

  • Periodontics
  • South Orange, NJ
  • NPI 1477671774
  NPD (past) Authorized official
• Kevin Darnell Johnson, DDS

  • Endodontics
  • South Orange, NJ
  • NPI 1366583841
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063634137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 VALLEY ST",
            "address_2": "SUITE103",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "07079",
            "telephone_number": "973-378-2070",
            "fax_number": "973-378-8334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 VALLEY ST",
            "address_2": "SUITE103",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "07079",
            "telephone_number": "973-378-2070",
            "fax_number": "973-378-8334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN DENTAL SPECIALTY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "973-378-2070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "NJ",
            "license": "15383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel Ross Sloan, LSW
• Sofia Shapiro, MD, LLC
• Mary Songonuga
• Sofoluwe O Songonuga, PT
• Beth L Sosin, MD
• South Mountain Orthopaedic Associates LLC
• South Orange Chiropractic Center
• South Orange Dental Center PA
• South Orange Dental Center, P.a.
• South Orange Healthcare Co

• Periodontics in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Periodontics in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.