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General NPI Number Information
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NPI Number | 1164865002
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Entity Type | Organization
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Legal Business Name | PRIME DENTAL CARE LLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 77 TAMARACK CIRCLE
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City | MONTGOMERY
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State | NJ
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Zip | 08558-1201
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Country | US
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Telephone | 609-688-8818
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Fax | 609-454-6116
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Provider Business Mailing Address
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Address Line | 77 TAMARACK CIRCLE
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City | MONTGOMERY
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State | NJ
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Zip | 08558-1201
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Country | US
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Telephone | 609-688-8818
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Fax | 609-454-6116
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUOJUN MA
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Credential | DDS PHD
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Telephone | 609-688-8818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02446500
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License Number State | NJ
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