Healthcare Provider Details

I. General information

NPI: 1821086869
Provider Name (Legal Business Name): GUTTENBERG DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 BERGENLINE AVE
GUTTENBERG NJ
07093-1826
US

IV. Provider business mailing address

6800 BERGENLINE AVE
GUTTENBERG NJ
07093-1826
US

V. Phone/Fax

Practice location:
  • Phone: 201-861-6000
  • Fax: 201-861-6002
Mailing address:
  • Phone: 201-861-6000
  • Fax: 201-861-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI-13595
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH P PRASAD
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 201-861-6000