Provider Demographics
NPI:1164865002
Name:PRIME DENTAL CARE LLC
Entity Type:Organization
Organization Name:PRIME DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUOJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHD
Authorized Official - Phone:609-688-8818
Mailing Address - Street 1:77 TAMARACK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-1201
Mailing Address - Country:US
Mailing Address - Phone:609-688-8818
Mailing Address - Fax:609-454-6116
Practice Address - Street 1:77 TAMARACK CIRCLE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NJ
Practice Address - Zip Code:08558-1201
Practice Address - Country:US
Practice Address - Phone:609-688-8818
Practice Address - Fax:609-454-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02446500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty