South Mountain Dental Specialty Group

NPI #1063634137 in South Orange, New Jersey

Provider Information

NPI Number: 1063634137
Entity Type: Organization
Organization Name: South Mountain Dental Specialty Group
Primary Specialty: Dentist - Periodontics
Enumeration Date: May 2, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 71 VALLEY ST
Address 2: SUITE103
City: South Orange
State: New Jersey
ZIP Code: 07079
Phone: (973) 378-2070

Authorized Official

Name: DR. RALPH C GRAY, DDS
Title: PARTNER
Phone: (973) 378-2070

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X	Primary

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