Provider Demographics
NPI:1053467878
Name:BAGOFF, ROBERT M (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BAGOFF
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4896
Mailing Address - Country:US
Mailing Address - Phone:973-535-6000
Mailing Address - Fax:973-535-6046
Practice Address - Street 1:315 E NORTHFIELD RD
Practice Address - Street 2:SUITE 3D
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4896
Practice Address - Country:US
Practice Address - Phone:973-535-6000
Practice Address - Fax:973-535-6046
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD150161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice