Provider Demographics
NPI:1982004297
Name:LE GOFF, ANNIA (DDS, MS, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANNIA
Middle Name:
Last Name:LE GOFF
Suffix:
Gender:F
Credentials:DDS, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1742
Mailing Address - Country:US
Mailing Address - Phone:973-800-6782
Mailing Address - Fax:
Practice Address - Street 1:5918 BERGENLINE AVE STE 201B
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1392
Practice Address - Country:US
Practice Address - Phone:201-662-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025978001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics