Provider Demographics
NPI:1093446007
Name:SLOBODIAN, ANDRII (DDS)
Entity Type:Individual
Prefix:
First Name:ANDRII
Middle Name:
Last Name:SLOBODIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 OUTWATER LN
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2604
Mailing Address - Country:US
Mailing Address - Phone:917-753-6453
Mailing Address - Fax:
Practice Address - Street 1:49 RIDGEDALE AVE STE 201
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1014
Practice Address - Country:US
Practice Address - Phone:973-822-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02909001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist