Provider Demographics
NPI:1851519672
Name:LAGOMARSINO, JOAN ROSEMARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ROSEMARY
Last Name:LAGOMARSINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WALLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1225
Mailing Address - Country:US
Mailing Address - Phone:973-473-5673
Mailing Address - Fax:
Practice Address - Street 1:175 WALLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1225
Practice Address - Country:US
Practice Address - Phone:973-473-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI140391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice