Provider Demographics
NPI:1730278938
Name:LO GIUDICE, ROBERT JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:LO GIUDICE
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 1:755 MEMORIAL PARKWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2748
Mailing Address - Country:US
Mailing Address - Phone:908-859-4498
Mailing Address - Fax:908-387-0767
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-859-4498
Practice Address - Fax:908-387-0767
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 159001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8193509Medicaid