Provider Demographics
NPI:1528748936
Name:LEBOV, EVAN ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ROBERT
Last Name:LEBOV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 MONMOUTH ST APT 330
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1322
Mailing Address - Country:US
Mailing Address - Phone:508-308-9660
Mailing Address - Fax:
Practice Address - Street 1:19 LEGION DR
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2314
Practice Address - Country:US
Practice Address - Phone:201-384-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029830001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice