Provider Demographics
NPI:1043436058
Name:THOGODE, MARK ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:THOGODE
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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:BRANCHVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07826-0810
Mailing Address - Country:US
Mailing Address - Phone:973-948-5000
Mailing Address - Fax:973-948-2280
Practice Address - Street 1:ONE COUNTRY LANE
Practice Address - Street 2:
Practice Address - City:BRANCHVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07826
Practice Address - Country:US
Practice Address - Phone:973-948-5000
Practice Address - Fax:973-948-2280
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ178631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice