Provider Demographics
NPI:1982753943
Name:JOHN M POGODA DMD AND STEPHEN D YAREMCZAK DMD PA
Entity type:Organization
Organization Name:JOHN M POGODA DMD AND STEPHEN D YAREMCZAK DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POGODA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-636-3220
Mailing Address - Street 1:850 WOODBRIDGE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095
Mailing Address - Country:US
Mailing Address - Phone:732-636-3220
Mailing Address - Fax:732-636-2269
Practice Address - Street 1:850 WOODBRIDGE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:732-636-3220
Practice Address - Fax:732-636-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01438200122300000X, 1223G0001X
NJ22DI01522800122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60006691Medicaid
NJ60006208Medicaid