MEDICARE: GOOD CARE DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1093494429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD CARE DENTAL PC

Provider Business Mailing Address
First Line	:	1509 PALISADE AVE FL 1
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5345
Country	:	US
Telephone Number	:	201-461-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 PALISADE AVE FL 1
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5345
Country	:	US
Telephone Number	:	201-461-2828
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	JOON HONG
Credential	:	DDS
Telephone Number	:	201-461-2828

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/14/2023

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Directions to “GOOD CARE DENTAL PC ” Practice Location

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