Provider Demographics
NPI:1225197361
Name:NORTH BERGEN FAMILY DENTAL CARE LLC
Entity Type:Organization
Organization Name:NORTH BERGEN FAMILY DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANORAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTUNUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-869-0030
Mailing Address - Street 1:7821 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4942
Mailing Address - Country:US
Mailing Address - Phone:201-869-0030
Mailing Address - Fax:201-869-0020
Practice Address - Street 1:7821 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4942
Practice Address - Country:US
Practice Address - Phone:201-869-0030
Practice Address - Fax:201-869-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI205201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1086983OtherHORIZON HEALTH CARE
985772OtherUNITED CONCORDIA
NJ016386OtherAMERIGROUP
NJ30536OtherAETNA
NJ20520OtherDELTA
NJ7794509Medicaid
223354OtherCIGNA