Prime Dental Care LLC

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02446500 Issued in NJ

Legal business name

PRIME DENTAL CARE LLC

Practice address

77 Tamarack Circle
Montgomery, NJ 08558-1201

Phone

(609) 688-8818

Fax

(609) 454-6116

NPI assigned

Apr 10, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Guojun Ma, DDS PHDNPI 1790098630

Title

Owner

Phone

(609) 688-8818

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Guojun Ma, DDS

  • General Practice Dentistry
  • Skillman, NJ
  • NPI 1790098630
  NPD Authorized official
• Elona Kaso, DMD

  • Dentist
  • Holmdel, NJ
  • NPI 1376914200
  NPD (past)
• Hanyi Leo Yu, DMD

  • Dentist
  • Lawrenceville, NJ
  • NPI 1912647389
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1164865002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 TAMARACK CIRCLE",
            "city": "MONTGOMERY",
            "state": "NJ",
            "postal_code": "085581201",
            "telephone_number": "609-688-8818",
            "fax_number": "609-454-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 TAMARACK CIRCLE",
            "city": "MONTGOMERY",
            "state": "NJ",
            "postal_code": "085581201",
            "telephone_number": "609-688-8818",
            "fax_number": "609-454-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-10",
        "last_updated": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "MA",
        "authorized_official_first_name": "GUOJUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-688-8818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS PHD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02446500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.