Provider Demographics
NPI:1306931290
Name:LOBODA, JOSEPH AUGUSTINE JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:AUGUSTINE
Last Name:LOBODA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:77 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2511
Mailing Address - Country:US
Mailing Address - Phone:973-992-8355
Mailing Address - Fax:973-992-4676
Practice Address - Street 1:687 KEARNY AVENUE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032
Practice Address - Country:US
Practice Address - Phone:207-997-5520
Practice Address - Fax:201-997-5532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008896001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6836801Medicaid
NJU24733Medicare UPIN
NJ6836801Medicaid