Provider Demographics
NPI:1659776516
Name:LODZIATO, SHIRLEY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:M
Last Name:LODZIATO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:M
Other - Last Name:PANIAGUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1195
Practice Address - Country:US
Practice Address - Phone:908-835-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025742001223P0221X, 1223G0001X
NY0590351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice