Provider Demographics
NPI:1982768800
Name:SOFOS, EFFIE (DMD)
Entity Type:Individual
Prefix:
First Name:EFFIE
Middle Name:
Last Name:SOFOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630
Mailing Address - Country:US
Mailing Address - Phone:201-967-7767
Mailing Address - Fax:201-967-7496
Practice Address - Street 1:309 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-967-7767
Practice Address - Fax:201-967-7496
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ170851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice