MEDICARE: NORTH BERGEN FAMILY 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	1223G0001X	General Practice Dentistry	DI20520	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1086983	OTHER		HORIZON HEALTH CARE
2	985772	OTHER		UNITED CONCORDIA
3	016386	OTHER	NJ	AMERIGROUP
4	30536	OTHER	NJ	AETNA
5	20520	OTHER	NJ	DELTA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	223354	OTHER		CIGNA

General Provider Information

NPI Number	:	1225197361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BERGEN FAMILY DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	7821 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4942
Country	:	US
Telephone Number	:	201-869-0030
Fax Number	:	201-869-0020

Provider Business Practice Location Address
First Line	:	7821 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4942
Country	:	US
Telephone Number	:	201-869-0030
Fax Number	:	201-869-0020

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. MANORAMA GUNTUNUR
Credential	:	DDS
Telephone Number	:	201-869-0030

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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