MEDICARE: WATCHUNG DENTAL CARE, 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	21228	NJ

General Provider Information

NPI Number	:	1861545527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATCHUNG DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	1801 E 2ND ST
Second Line	:	SUITE 1
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1749
Country	:	US
Telephone Number	:	908-322-6090
Fax Number	:	908-322-6096

Provider Business Practice Location Address
First Line	:	1801 E 2ND ST
Second Line	:	SUITE 1
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1749
Country	:	US
Telephone Number	:	908-322-6090
Fax Number	:	908-322-6096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANG HO MOON
Credential	:	D.D.S.
Telephone Number	:	908-322-6090

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/22/2020

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