Organization
NORTH BERGEN FAMILY DENTAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANORAMA GUNTUNUR DDS (GENERAL DENTIST)
(201) 869-0030
Entity
Organization
Contact information
Practice address
7821 BERGENLINE AVE, NORTH BERGEN, NJ 07047-4942
(201) 869-0030
(201) 869-0020
Mailing address
7821 BERGENLINE AVE, NORTH BERGEN, NJ 07047-4942
(201) 869-0030
(201) 869-0020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DI20520
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016386
AMERIGROUP
NJ
01
—
1086983
HORIZON HEALTH CARE
—
01
—
20520
DELTA
NJ
01
—
223354
CIGNA
—
01
—
30536
AETNA
NJ
05
—
7794509
—
NJ
01
—
985772
UNITED CONCORDIA
—
Enumeration date
12/06/2006
Last updated
08/22/2020
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