Provider Demographics
NPI:1114248846
Name:O'GRODNICK, ERIN ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ANNE
Last Name:O'GRODNICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-2126
Mailing Address - Country:US
Mailing Address - Phone:908-236-9650
Mailing Address - Fax:
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-2126
Practice Address - Country:US
Practice Address - Phone:908-236-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2435700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist