Provider Demographics
NPI:1134349335
Name:BALOGH, EVA (DMD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:BALOGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:MOOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 RT 46 WEST
Mailing Address - Street 2:B15
Mailing Address - City:MT LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046
Mailing Address - Country:US
Mailing Address - Phone:973-402-1530
Mailing Address - Fax:973-402-0446
Practice Address - Street 1:115 RT 46 WEST
Practice Address - Street 2:B15
Practice Address - City:MT LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046
Practice Address - Country:US
Practice Address - Phone:973-402-1530
Practice Address - Fax:973-402-0446
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist