Provider Demographics
NPI:1164384277
Name:RIDE ORAL SURGERY SUMMIT PC
Entity type:Organization
Organization Name:RIDE ORAL SURGERY SUMMIT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHROTRA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DDS, MD
Authorized Official - Phone:908-395-0111
Mailing Address - Street 1:1 SPRINGFIELD AVE STE 2D
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4055
Mailing Address - Country:US
Mailing Address - Phone:908-395-0111
Mailing Address - Fax:
Practice Address - Street 1:1 SPRINGFIELD AVE STE 2D
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-395-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-26
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery