Individual
EVAN RIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 WALNUT ST STE 1302, PHILADELPHIA, PA 19102-2908
(215) 568-6222
Mailing address
1601 WALNUT ST STE 1302, PHILADELPHIA, PA 19102-2908
(215) 568-6222
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS041185
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/02/2016
Last updated
09/18/2020
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