Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI01438200 | NJ |
N | 1223D0001X | Dental Public Health | 22DI01438200 | NJ |
NPI | 1497811228 |
---|---|
Provider Name | Dr. John Pogoda |
First Address | Parlin, NJ 08859 |
Second Address | Woodbridge, NJ 07095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 25/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60006691 | (05) | NJ |