MEDICARE: PRIME DENTAL CARE LLC

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	122300000X	Dentist	22DI02446500	NJ

General Provider Information

NPI Number	:	1164865002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	77 TAMARACK CIRCLE
Second Line	:
City	:	MONTGOMERY
State	:	NJ
Zip	:	08558-1201
Country	:	US
Telephone Number	:	609-688-8818
Fax Number	:	609-454-6116

Provider Business Practice Location Address
First Line	:	77 TAMARACK CIRCLE
Second Line	:
City	:	MONTGOMERY
State	:	NJ
Zip	:	08558-1201
Country	:	US
Telephone Number	:	609-688-8818
Fax Number	:	609-454-6116

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GUOJUN MA
Credential	:	DDS PHD
Telephone Number	:	609-688-8818

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	03/19/2024

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