Ridgewood Dentistry, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

22DI01155300 Issued in NJ

Legal business name

RIDGEWOOD DENTISTRY, LLC

Practice address

75 Chestnut St
Ridgewood, NJ 07450-2501

Phone

(201) 445-4808

Fax

(201) 445-9081

NPI assigned

May 16, 2007

Organization subpart

No

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

Authorized official

Name

Glenn P Godart, DMD

Title

Owner

Phone

(201) 445-4808

Specialties & licenses 1

Addresses

Other names 1

• Glenn P Godart Doing business as

Locations

Practitioners 1

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

• Warren Elliot Boardman, DMD

  • Dentist
  • Ridgewood, NJ
  • NPI 1427096924
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093922700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 CHESTNUT ST",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502501",
            "telephone_number": "201-445-4808",
            "fax_number": "201-445-9081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 CHESTNUT ST",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502501",
            "telephone_number": "201-445-4808",
            "fax_number": "201-445-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGEWOOD DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GODART",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-445-4808",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI01155300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenn P Godart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ridgewood Board of Education
• Ridgewood Chiropractic
• Ridgewood Corset Shop Inc
• Ridgewood Dental Associates, LLC
• Ridgewood Dental Group LLC
• Ridgewood ENT & Dermatology
• Ridgewood Eye Care & Wear LLC
• Ridgewood Foot Center
• Ridgewood House of Wellness LLC
• Ridgewood Infectious Disease Associates, PA

• Dentist in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Dentist 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.