Healthcare Provider Details

I. General information

NPI: 1962692988
Provider Name (Legal Business Name): WAYNE J JOSEPH, D.D.S.,MS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10751 WHITTIER ST
DETROIT MI
48224-1754
US

IV. Provider business mailing address

10751 WHITTIER ST 19010 W TEN MILE RD
DETROIT MI
48224-1754
US

V. Phone/Fax

Practice location:
  • Phone: 313-521-5800
  • Fax: 734-721-4746
Mailing address:
  • Phone: 313-521-5800
  • Fax: 734-721-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12348
License Number StateMI

VIII. Authorized Official

Name: DR. WAYNE J JOSEPH
Title or Position: DR.
Credential: D.D.S.
Phone: 313-521-5800