Provider Demographics
NPI:1053515916
Name:RALFF, EDGAR ALBERT JR (DMD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ALBERT
Last Name:RALFF
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:YARDVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-2105
Mailing Address - Country:US
Mailing Address - Phone:609-585-4545
Mailing Address - Fax:609-585-8856
Practice Address - Street 1:4210 S BROAD ST
Practice Address - Street 2:
Practice Address - City:YARDVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08620-2105
Practice Address - Country:US
Practice Address - Phone:609-585-4545
Practice Address - Fax:609-585-8856
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist