Provider Demographics
NPI:1790098630
Name:MA, GUOJUN (DDS)
Entity Type:Individual
Prefix:
First Name:GUOJUN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 TAMARACK CIR
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2019
Mailing Address - Country:US
Mailing Address - Phone:609-688-8818
Mailing Address - Fax:609-454-6116
Practice Address - Street 1:77 TAMARACK CIR
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2019
Practice Address - Country:US
Practice Address - Phone:609-688-8818
Practice Address - Fax:609-454-6116
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024465001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice