Provider Demographics
NPI:1629339866
Name:CARDOSO, LUCIO ANTONIO JR (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:LUCIO
Middle Name:ANTONIO
Last Name:CARDOSO
Suffix:JR
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:10 DRS JAMES PARKER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1500
Mailing Address - Country:US
Mailing Address - Phone:732-426-0552
Mailing Address - Fax:732-426-0553
Practice Address - Street 1:10 DRS JAMES PARKER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1500
Practice Address - Country:US
Practice Address - Phone:732-426-0552
Practice Address - Fax:732-426-0553
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2024-08-27
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Provider Licenses
StateLicense IDTaxonomies
NJ22DI026706001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty