Healthcare Provider Details

I. General information

NPI: 1063332898
Provider Name (Legal Business Name): EDISON GENTLE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 BRIDGE ST
METUCHEN NJ
08840-2294
US

IV. Provider business mailing address

257 BRIDGE ST
METUCHEN NJ
08840-2294
US

V. Phone/Fax

Practice location:
  • Phone: 917-932-3154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JIAJIA YU
Title or Position: OWNER
Credential:
Phone: 917-932-3154