# OAK RIDGE DENTAL & SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OAK RIDGE DENTAL & SURGERY, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1720556749
- **Legal business name:** OAK RIDGE DENTAL & SURGERY, LLC
- **Authorized official:** DR. MUZAFFAR M SHAH-KHAN DDS (CEO/OWNER)
- **Authorized official phone:** (219) 285-3016

## Contact information

- **Practice address:** 5815 CALUMET AVE, HAMMOND, IN 46320-2352
- **Practice address phone:** (219) 285-3016
- **Mailing address:** 5815 CALUMET AVE, HAMMOND, IN 46320-2352
- **Mailing address phone:** (219) 285-3016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2018
- **Last updated:** 11/07/2018