Provider Demographics
NPI:1962588350
Name:FODOR, MICHAEL E (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:FODOR
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 1:962 US HIGHWAY 202 S
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3732
Mailing Address - Country:US
Mailing Address - Phone:908-722-0880
Mailing Address - Fax:908-722-7927
Practice Address - Street 1:962 US HIGHWAY 202 S
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3732
Practice Address - Country:US
Practice Address - Phone:908-722-0880
Practice Address - Fax:908-722-7927
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ92831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice