Healthcare Provider Details

I. General information

NPI: 1417053554
Provider Name (Legal Business Name): YUSUN GOHARD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 RIDGEDALE AVENUE
FLORHAM PARK NJ
07932
US

IV. Provider business mailing address

66 RIDGEDALE AVENUE
FLORHAM PARK NJ
07932
US

V. Phone/Fax

Practice location:
  • Phone: 973-377-2222
  • Fax: 201-653-3581
Mailing address:
  • Phone: 973-377-2222
  • Fax: 201-653-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD102255300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: