MEDICARE: FAMILY UNION DENTAL PRACTICE

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

General Provider Information

NPI Number	:	1407933849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY UNION DENTAL PRACTICE

Provider Business Mailing Address
First Line	:	2713 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3706
Country	:	US
Telephone Number	:	201-865-1353
Fax Number	:	201-865-1556

Provider Business Practice Location Address
First Line	:	2713 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3706
Country	:	US
Telephone Number	:	201-865-1353
Fax Number	:	201-865-1556

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MILAGROS JOAN GATON-MUNOZ
Credential	:	DD.S
Telephone Number	:	201-865-1353

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/06/2023

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