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Organization
RIDGE DENTAL GROUP PLLC
Active
Organization
RIDGE DENTAL GROUP PLLC
Active
Other names
Ridge Dental and Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI ELLEN VANHOUTEN- GRUBBS (PARTNER)
(870) 238-2600
Entity
Organization
Contact information
Practice address
808 HIGHWAY 64 E, WYNNE, AR 72396-7414
(870) 238-2600
Mailing address
808 HIGHWAY 64 E, WYNNE, AR 72396-7414
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/21/2021
Last updated
12/21/2021
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